Individual
MARTINA N/A MIKULIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
304 E JACKSON ST STE 2F, WILLARD, MO 65781-9472
(417) 221-4667
Mailing address
PO BOX 257, WILLARD, MO 65781-0257
(417) 221-4667
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2024025501
MO
225100000X
Physical Therapist
PT029692
PA
Other
Enumeration date
09/08/2021
Last updated
07/15/2024
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