Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 103314 | MO |
NPI | 1265705917 |
---|---|
Provider Name | Kristin Kay Allen |
First Address | Eureka, MO 63025-2379 |
Second Address | Saint Louis, MO 63146-3010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 10/02/2012 |