Individual
MRS. THERESA KAY ODENTHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1 CHILDRENS PL, SAINT LOUIS, MO 63110-1002
(314) 454-6154
Mailing address
517 S RAPP AVE, COLUMBIA, IL 62236-2432
(618) 974-9325
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116067
MO
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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