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General NPI Number Information
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NPI Number | 1770146169
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Entity Type | Individual
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Provider Name | RAMONA ELAINE HEISLER PTA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2019
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Last Update Date | 04/21/2019
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Provider Practice Location Address
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Address Line | 1406 W BUSINESS LOOP 70
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City | COLUMBIA
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State | MO
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Zip | 65202-1324
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Country | US
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Telephone | 573-449-5287
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Fax |
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Provider Business Mailing Address
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Address Line | 732 7TH ST
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City | BOONVILLE
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State | MO
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Zip | 65233-1610
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Country | US
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Telephone | 660-537-6403
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 116687
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License Number State | MO
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