Individual
THOMAS DANNENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAED, LAT, ATC
Contact information
Practice address
209 S KINGSHIGHWAY ST, SAINT CHARLES, MO 63301-1693
(618) 560-3298
Mailing address
1015 CORPORATE SQUARE DR STE 220, SAINT LOUIS, MO 63132-2938
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2014025141
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000017249
BOARD OF CERTIFICATION
MO
01
—
2014025141
MISSOURI DIVISION OF PROFESSIONAL REGISTRATION
MO
Enumeration date
04/12/2017
Last updated
06/15/2023
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