Healthcare Provider Details

I. General information

NPI: 1578783825
Provider Name (Legal Business Name): STACY WORSHAM CROSSLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STRAFFORD R-VI 201 W MCCABE ST
STRAFFORD MO
65757-8841
US

IV. Provider business mailing address

201 W MCCABE ST
STRAFFORD MO
65757-8841
US

V. Phone/Fax

Practice location:
  • Phone: 417-736-7000
  • Fax: 417-736-7016
Mailing address:
  • Phone: 417-736-7000
  • Fax: 417-736-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number117500
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: