Individual
MIKKAELA SUNTRUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3501 DUNN RD STE 108, FLORISSANT, MO 63033-6762
(314) 972-8070
Mailing address
5755 MARDEL AVE, SAINT LOUIS, MO 63109-1551
(314) 540-6440
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2016025193
MO
Other
Enumeration date
10/24/2021
Last updated
10/24/2021
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