Individual
SHANNON LEIGH BLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, PTA
Contact information
Practice address
1120 W COMMERCE DR STE 100, FESTUS, MO 63028-2392
(636) 224-7511
Mailing address
647 SPIRIT AIRPARK WEST DR STE 101, CHESTERFIELD, MO 63005-1032
(636) 206-4225
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2019027232
MO
2255A2300X
Athletic Trainer
113979
MO
Other
Enumeration date
05/09/2007
Last updated
09/13/2023
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