Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2001006769 | MO |
NPI | 1104983154 |
---|---|
Provider Name | Ann Elizabeth Boschert |
First Address | Weldon Spring, MO 63304-2227 |
Second Address | Weldon Spring, MO 63304-2227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |