Individual
MRS. MARY MIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1015 BOWLES AVE, FENTON, MO 63026-2394
(636) 496-2430
(636) 496-4951
Mailing address
2960 WILLOW CREEK ESTATES DR, FLORISSANT, MO 63031-1662
(314) 960-1856
(636) 496-4951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02099
MO
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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