Provider Demographics
NPI:1033570874
Name:WOMBLE, VALERIE JOURNEY (LMT, MA, CPHT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JOURNEY
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:LMT, MA, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 COUNTY HIGHWAY 582
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-8196
Mailing Address - Country:US
Mailing Address - Phone:573-575-9822
Mailing Address - Fax:
Practice Address - Street 1:115 COUNTY HIGHWAY 582
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-8196
Practice Address - Country:US
Practice Address - Phone:573-575-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015038400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist