Individual
GREGORY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5029 SHAW AVE, SAINT LOUIS, MO 63110-3021
(314) 504-2493
Mailing address
5029 SHAW AVE, SAINT LOUIS, MO 63110-3021
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2005032955
MO
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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