Individual
LAURA MARIE SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1011 BOWLES AVE STE 150, FENTON, MO 63026-2384
(636) 334-3955
Mailing address
1011 BOWLES AVE STE 150, FENTON, MO 63026-2384
(636) 334-3955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/05/2010
Last updated
08/05/2010
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