Healthcare Provider Details

I. General information

NPI: 1699978841
Provider Name (Legal Business Name): JAMIE BAX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCR - 65 BOX 6, HIGHWAY 63
WESTPHELIA MO
65085
US

IV. Provider business mailing address

76 OAK RIDGE TRL
FREEBURG MO
65035-2050
US

V. Phone/Fax

Practice location:
  • Phone: 615-896-6400
  • Fax:
Mailing address:
  • Phone: 573-455-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number904
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: