Individual
TONY MOUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
676 RIVOLI ST, SAINT PAUL, MN 55130-4422
(612) 702-4202
Mailing address
676 RIVOLI ST, SAINT PAUL, MN 55130-4422
(612) 702-4202
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A2625
MN
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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