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NPI Code Detail

MEDICARE: RYAN PEZLEY

MEDICARE: RYAN PEZLEY
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
1225200000XPhysical Therapy Assistant2007028410MO

General Provider Information

NPI Number : 1174854368
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN PEZLEY
Provider Business Mailing Address
First Line : 1701 LAWRENCE PL
Second Line :
City : MEXICO
State : MO
Zip : 65265-3422
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 LAWRENCE PL
Second Line :
City : MEXICO
State : MO
Zip : 65265-3422
Country : US
Telephone Number : 573-581-4452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2010
Last Update Date : 01/27/2010

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Directions to “ RYAN PEZLEY ” Practice Location

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