Individual
MARTIN MALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1 VILLAGE SQ, SUITE A, HAZELWOOD, MO 63042-1817
(314) 551-6154
(314) 551-6105
Mailing address
1 VILLAGE SQ, SUITE A, HAZELWOOD, MO 63042-1817
(314) 551-6154
(314) 551-6105
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2002027725
MO
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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