Individual
EVAN COONROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
239 STEAMBOAT LN, BALLWIN, MO 63011-3203
(314) 570-9717
Mailing address
239 STEAMBOAT LN, BALLWIN, MO 63011-3203
(314) 570-9717
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2018012292
MO
Other
Enumeration date
11/02/2020
Last updated
11/02/2020
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