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Individual

DR. VIRGINIA KAY KETTENBACH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PT,PHD

Contact information

Practice address
3437 CAROLINE ST., ROOM 1030, ST. LOUIS, MO 63104
(314) 977-8543
(314) 977-8513
Mailing address
1123 CHATELET DR., FERGUSON, MO 63135-1334
(314) 977-8543
(314) 977-8513

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RO313
MO

Other

Enumeration date
03/08/2007
Last updated
07/08/2007
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