Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | MO |
NPI | 1437666716 |
---|---|
Provider Name | Amy Son |
First Address | Saint Louis, MO 63106-1621 |
Second Address | Saint Louis, MO 63106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2018 |
Last Update Date | 08/01/2018 |