Individual
CHARLENE WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(636) 388-1707
Mailing address
3337 EMINENCE BLVD, SAINT LOUIS, MO 63114-4219
(636) 388-1707
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2019027412
MO
Other
Enumeration date
04/18/2020
Last updated
04/18/2020
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