Organization
MHT SENIOR WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIONNESHAE FORLAND (OWNER)
(314) 524-3958
Entity
Organization
Contact information
Practice address
9191 W FLORISSANT AVE STE 200, SAINT LOUIS, MO 63136-1424
(314) 524-3958
(314) 524-3959
Mailing address
9191 W FLORISSANT AVE STE 200, SAINT LOUIS, MO 63136-1424
(314) 524-3958
(314) 524-3959
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2007006528
MO
225200000X
Physical Therapy Assistant
116922
MO
225200000X
Physical Therapy Assistant
117525
MO
225200000X
Physical Therapy Assistant
2008020852
MO
Other
Enumeration date
01/18/2013
Last updated
01/18/2013
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