Individual
MARY ELIZABETH BOOMGARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9645 BIG BEND BOULEVARD, SAINT LOUIS, MO 63122
(314) 968-5460
Mailing address
9645 BIG BEND BOULEVARD, SAINT LOUIS, MO 63122
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2014027179
MO
Other
Enumeration date
02/18/2015
Last updated
02/18/2015
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