Individual
MACY SOPHANAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3639 N SAINT PETERS PKWY, SAINT PETERS, MO 63376-7303
(309) 256-2899
Mailing address
6658 BERTHOLD AVE APT 1F, SAINT LOUIS, MO 63139-3319
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2024034830
MO
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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