Individual
TYLER I EDGERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2836 WATSON RD, SAINT LOUIS, MO 63139-2621
(314) 368-4408
Mailing address
2836 WATSON RD, SAINT LOUIS, MO 63139-2621
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2017036514
MO
Other
Enumeration date
10/16/2019
Last updated
10/16/2019
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