Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 01753 | MO |
NPI | 1003184649 |
---|---|
Provider Name | Deborah Harre |
First Address | Saint Louis, MO 63105-1801 |
Second Address | Valley Park, MO 63088-1447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2011 |
Last Update Date | 10/12/2011 |