Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2003026732 | MO |
Y | 213ES0000X | Sports Medicine | 2003026732 | MO |
NPI | 1124237490 |
---|---|
Provider Name | Mrs. Tracy L Pulley |
First Address | Saint Charles, MO 63301-4857 |
Second Address | Ballwin, MO 63021-5899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |