Individual
MARY SUSAN PERNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2011 CORONA RD STE 301, COLUMBIA, MO 65203-2548
(314) 543-3861
Mailing address
411 ROBERT AVE, FERGUSON, MO 63135-3526
(314) 524-6191
(314) 524-6191
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116138
MO
Other
Enumeration date
09/29/2012
Last updated
09/29/2012
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