Individual
LYRA RIVERA PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
250 NEW FLORISSANT RD S, FLORISSANT, MO 63013
(314) 830-7950
Mailing address
12858 STRATHEARN DR, ST LOUIS, MO 63146
(314) 307-1714
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
100097
MO
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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