Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2020036617 | MO |
NPI | 1013596980 |
---|---|
Provider Name | Michael Wesley Mueller |
First Address | Saint Louis, MO 63139-2137 |
Second Address | Glenview, IL 60026-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2021 |
Last Update Date | 06/04/2021 |