| NPI | 1336227511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN K EVERSON Physical Therapist/Administrator 314-991-2562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 01532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 00423) |
| 225200000X Physical Therapy Assistant (Licence: MO 2005035740) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |