Basic Information
| Provider Information | |||||||||
| NPI: | 1366646739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIEHR | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23399 HIGHWAY 32 | ||||||||
| Address2: | LOT 4 | ||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655365187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175883623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 331 HOSPITAL DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655369217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4175336315 | ||||||||
| FaxNumber: | 4175336320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2004033976 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.