| NPI | 1053690404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE MANGRUM Office Manager 314-275-8737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2012-08-03 |