Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 110509 | MO |
NPI | 1528339629 |
---|---|
Provider Name | Keith Sanders |
First Address | Saint Louis, MO 63126-1037 |
Second Address | Saint Louis, MO 63126-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2012 |
Last Update Date | 20/01/2012 |