Individual
TORACE LAMONT DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2745 VALLEY BROOK DR, FLORISSANT, MO 63031-1982
(314) 915-1563
Mailing address
2745 VALLEY BROOK DR, FLORISSANT, MO 63031-1982
(314) 915-1563
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2020014659
MO
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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