Individual
RALPH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7300 FOX CHASE DR, SAINT CHARLES, MO 63301-8360
(314) 546-7517
Mailing address
7300 FOX CHASE DR, SAINT CHARLES, MO 63301-8360
(314) 546-7517
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2008022372
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2008022372
—
MO
Enumeration date
08/02/2011
Last updated
08/02/2011
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