Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013061050 |
---|---|
Provider Name | Mr. Earl Ellis Mccrary III |
First Address | Des Peres, MO 63131-1865 |
Second Address | Des Peres, MO 63131-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |