Individual
MARY DAVISSON MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1700B GILSINN LN, FENTON, MO 63026-2004
(636) 343-6279
(636) 343-6279
Mailing address
96 BAL HARBOUR DR, SAINT LOUIS, MO 63146-5377
(636) 343-6279
(636) 343-6279
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01589
MO
Other
Enumeration date
06/30/2006
Last updated
09/16/2011
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