Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2019027372 | MO |
NPI | 1013686567 |
---|---|
Provider Name | Erin Mccullough |
First Address | Saint Louis, MO 63109-3540 |
Second Address | Saint Louis, MO 63109-3540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2021 |
Last Update Date | 08/09/2021 |