Individual
MICAH BOLANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
3520 CHOUTEAU AVE, SAINT LOUIS, MO 63103-2916
(314) 771-2100
Mailing address
849 LONGACRE APT. B, SAINT LOUIS, MO 63132-4737
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2006038245
MO
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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