Organization
MARA A GARDNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARA GARDNER (PRESIDENT)
(636) 916-3104
Entity
Organization
Contact information
Practice address
2101 COLLIER CORP PARKWAY, ST. CHARLES, MO 63303
(636) 916-3104
Mailing address
609 OREGON TRAIL DR, SAINT CHARLES, MO 63304-7983
(636) 916-3104
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01549
MO
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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