Individual
MRS. ELISHA ANNE GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
801 N 11TH ST, MEDICAID DEPARTMENT, SAINT LOUIS, MO 63101-1015
(314) 345-2535
(314) 345-2653
Mailing address
1868 COTTONWOOD DR, IMPERIAL, MO 63052-1573
(636) 464-6016
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2001008315
MO
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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