Provider Demographics
NPI:1528464104
Name:AVELLANOSA, ANNA MARIE BAUTISTA (PT)
Entity type:Individual
Prefix:MRS
First Name:ANNA MARIE
Middle Name:BAUTISTA
Last Name:AVELLANOSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3735
Mailing Address - Country:US
Mailing Address - Phone:417-339-4069
Mailing Address - Fax:
Practice Address - Street 1:525 BRANSON LANDING BLVD.
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-348-8212
Practice Address - Fax:417-348-8218
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPT111250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist