Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 2008016030 | MO |
NPI | 1245554997 |
---|---|
Provider Name | Johanna Maria Paniagua |
First Address | Saint Louis, MO 63125-4108 |
Second Address | Saint Louis, MO 63125-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2010 |
Last Update Date | 24/03/2010 |