Provider Demographics
NPI:1144436056
Name:STAMPER, PATRECIA P (PTA)
Entity type:Individual
Prefix:MS
First Name:PATRECIA
Middle Name:P
Last Name:STAMPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2209
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402-2209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1507 OAK FOREST DR
Practice Address - Street 2:A
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-9378
Practice Address - Country:US
Practice Address - Phone:573-364-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117343225200000X
KS14-00155225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant