Organization
ABILITY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE BENTON-BLACK (PHYSICAL THERAPIST)
(573) 883-8181
Entity
Organization
Contact information
Practice address
284 MERCHANT ST, STE GENEVIEVE, MO 63670-1610
(573) 883-8181
Mailing address
379 EL TAMPA RD, CAMDENTON, MO 65020-4338
(573) 280-6258
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
2001021506
MO
Other
Enumeration date
06/04/2014
Last updated
05/22/2015
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