Individual
WESLEY GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3301 BERRYWOOD DR STE 204, #204, COLUMBIA, MO 65201-6517
(573) 449-8771
Mailing address
19424 HIGHWAY 54, LOUISIANA, MO 63353-3807
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2019027967
MO
Other
Enumeration date
08/02/2016
Last updated
08/19/2016
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