Organization
SUPPLEMENTAL HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA RENEE PRUTCH PTA (PHYSICAL THERAPIST ASSISTANT)
(719) 214-0922
Entity
Organization
Contact information
Practice address
11960 WESTLINE INDUSTRIAL DR STE 201, SAINT LOUIS, MO 63146-3209
(314) 819-0480
Mailing address
11960 WESTLINE INDUSTRIAL DR STE 201, SAINT LOUIS, MO 63146-3209
(314) 819-0480
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
2008015492
MO
Other
Enumeration date
06/22/2011
Last updated
06/22/2011
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