| NPI | 1023356474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIONNESHAE FORLAND Owner 314-524-3958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2007006528) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MO 116922) |
| 225200000X Physical Therapy Assistant (Licence: MO 2008020852) | |
| 225200000X Physical Therapy Assistant (Licence: MO 117525) | |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2013-01-18 |