Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 2015027195 | MO |
NPI | 1114303369 |
---|---|
Provider Name | Kevin Murray |
First Address | Saint Louis, MO 63119-4414 |
Second Address | Saint Louis, MO 63119-4414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2015 |
Last Update Date | 10/08/2015 |