Individual
KATIE GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1096 TOM GINNEVER AVE, O FALLON, MO 63366-4519
(636) 978-5255
Mailing address
2454 W CLAY ST, SAINT CHARLES, MO 63301-2548
(636) 949-3926
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2017021667
MO
Other
Enumeration date
06/26/2017
Last updated
03/11/2021
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