Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2007034111 | MO |
NPI | 1033525076 |
---|---|
Provider Name | Kathleen Korona |
First Address | Saint Louis, MO 63106-1621 |
Second Address | Saint Louis, MO 63106-1621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 10/07/2014 |