Provider Demographics
NPI:1003225962
Name:STUCKENSCHNEIDER, TASHA
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:STUCKENSCHNEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 OSAGE BEACH PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3188
Mailing Address - Country:US
Mailing Address - Phone:573-693-9128
Mailing Address - Fax:
Practice Address - Street 1:5780 OSAGE BEACH PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3188
Practice Address - Country:US
Practice Address - Phone:573-693-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist