Individual
MRS. STACY JO KETTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1108 CLARKE ST, DE SOTO, MO 63020-2706
(636) 586-0895
Mailing address
2827 HEATHER WOOD LN, FESTUS, MO 63028-3140
(636) 931-2327
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2000152525
MO
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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