Individual
MADELINE DELAY GIFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4624 LANSDOWNE AVE, SAINT LOUIS, MO 63116-1523
(314) 351-6888
Mailing address
303 NEPUTE ST, MARYVILLE, IL 62062-6628
(618) 263-7873
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2020036393
MO
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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