Individual
AUTUMN CORTIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 S KIRKWOOD RD STE 140, SAINT LOUIS, MO 63122-7250
(314) 821-5300
Mailing address
936 SMITHSHIRE AVE, FERGUSON, MO 63135-1767
(314) 524-4504
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116682
LICENSE #
MO
Enumeration date
08/30/2006
Last updated
07/08/2007
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