Jerome Gerongco Canama, PT
Individual provider Active NPI Physical Therapist · Mexico, MO
NPI 1992983142 · NPPES record last updated Feb 8, 2008
Key facts
- NPI
- 1992983142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2005040393 (MO)
- Practice address
- 407 Yale St
Mexico, MO 65265-2340 - Phone
- (925) 285-4422
- NPI assigned
- Feb 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005040393 | MO | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2005040393 | MO | Yes |
Addresses
Primary practice location
407 Yale St
Mexico, MO 65265-2340
Mailing address
407 Yale St
Mexico, MO 65265-2340
Phone (925) 285-4422
Other providers in Mexico, MO
- Burle Chiropractic Inc.
- Kenneth Gerard Burle Jr.
- Jennifer Rene Buswell
- Dennis Ray Campbell
- Morgan R Campbell
- Calvin James Canine
- Virginia J Caputy
- Alyssa Ann Carlisle
- John V Carlson
- Sharon Parker Carmignani
All providers in Mexico, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.