Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 01160 | MO |
NPI | 1346628708 |
---|---|
Provider Name | Jo Ann Roberts |
First Address | Saint Louis, MO 63132-5004 |
Second Address | Creve Coeur, MO 63141-6603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 18/05/2015 |