Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2001026575 | MO |
NPI | 1043608144 |
---|---|
Provider Name | Elka Follmer |
First Address | Saint Louis, MO 63102-1154 |
Second Address | Festus, MO 63028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2014 |
Last Update Date | 26/12/2014 |