Individual
IBRAHIM ATIQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16740 HICKORY CREST DR, WILDWOOD, MO 63011-5501
(636) 675-9075
Mailing address
16740 HICKORY CREST DR, WILDWOOD, MO 63011-5501
(636) 675-9075
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2020029962
MO
Other
Enumeration date
07/12/2021
Last updated
07/27/2021
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