Individual
GAY AMPO BIGCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
801 BRIM ST, DESLOGE, MO 63601-3441
(573) 431-0223
Mailing address
400 MAPLE VALLEY DR, APT 1, FARMINGTON, MO 63640-1979
(713) 732-9132
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2006032818
MO
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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