Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2017036589 | MO |
NPI | 1013490176 |
---|---|
Provider Name | Salena Victoria Poston |
First Address | Sikeston, MO 63801-3960 |
Second Address | Sikeston, MO 63801-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 13/09/2018 |