Individual
MRS. SANDRA ANN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3645 COOK, ST LOUIS, MO 63113
(314) 531-2352
Mailing address
7321 OVERBROOK DR, ST LOUIS, MO 63121
(314) 261-3874
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
00146
MO
Other
Enumeration date
02/25/2008
Last updated
02/25/2008
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