Individual
MIKE INOCENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1100 E OUTER RD S STE 1, CANTON, MO 63435-1701
(573) 288-3311
(573) 288-1223
Mailing address
1100 E OUTER RD S STE 1, PO BOX 244, CANTON, MO 63435-1701
(573) 288-3311
(573) 288-1223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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