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Individual
MR. THEODORE JAMES ST. JOHN
Active
Individual
MR. THEODORE JAMES ST. JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501301844
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S325792367996
DRIVERS LICENSE
MI
Enumeration date
05/11/2022
Last updated
06/09/2022
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