Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 00075 | MO |
NPI | 1396883831 |
---|---|
Provider Name | Mrs. Joan Ann Puglisi |
First Address | Webster Groves, MO 63119-4042 |
Second Address | Webster Groves, MO 63119-4042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ER019905304, CODE C1 | (05) | MO |