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NPI Code Detail

MEDICARE: MANDY JOLENE SCHLESSELMANN PT, ATC

MEDICARE: MANDY JOLENE SCHLESSELMANN PT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2005019093MO
22255A2300XAthletic Trainer2004022186MO
3225100000XPhysical TherapistPT 36445CA

General Provider Information

NPI Number : 1023132057
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY JOLENE SCHLESSELMANN PT, ATC
Provider Business Mailing Address
First Line : 1887 N HWY CC
Second Line :
City : NIXA
State : MO
Zip : 65714-8015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1887 N HWY CC
Second Line :
City : NIXA
State : MO
Zip : 65714-8015
Country : US
Telephone Number : 417-725-5774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 05/09/2014

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