Individual
MONICA ANNE RAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11960 WESTLINE INDUSTRIAL DR STE 201, SAINT LOUIS, MO 63146-3209
(870) 404-3944
Mailing address
1212 HOLGATE DR, MANCHESTER, MO 63021-6868
(870) 404-3944
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1811
AR
225200000X
Physical Therapy Assistant
2014012166
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141377721
—
AR
Enumeration date
01/24/2007
Last updated
07/22/2014
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