Individual
TISH S. KETTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
7700 CLAYTON RD, SUITE 311, SAINT LOUIS, MO 63117-1328
(314) 283-6936
Mailing address
7700 CLAYTON RD, SUITE 311, SAINT LOUIS, MO 63117-1328
(314) 283-6936
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070.010801
IL
225100000X
Physical Therapist
Primary
114355
MO
Other
Enumeration date
01/16/2017
Last updated
01/16/2017
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