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Individual

CHARLES B MCDONNELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, CHT

Contact information

Practice address
4800 MEXICO RD, SUITE 104, ST PETERS, MO 63376-1666
(636) 939-9540
(636) 939-9886
Mailing address
2454 W CLAY ST, SAINT CHARLES, MO 63301-2548
(636) 916-4625
(636) 916-4628

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01008
MO
2251H1200X
Hand Physical Therapist
9209001425
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00165252
RAILROAD MEDICARE
MO
Enumeration date
05/22/2006
Last updated
09/11/2012
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