Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2009024428 | MO |
NPI | 1033468301 |
---|---|
Provider Name | Jacqueline Kaye Rosenthal |
First Address | Fenton, MO 63026-8009 |
Second Address | Arnold, MO 63010-6015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2012 |
Last Update Date | 02/09/2012 |