Individual
STACEY M VITALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1405 N MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63701-2171
(573) 335-7868
(573) 335-8193
Mailing address
1405 N MOUNT AUBURN RD, CAPE GIRARDEAU, MO 63701-2171
(573) 335-7868
(573) 335-8193
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2013011400
MO
Other
Enumeration date
08/21/2013
Last updated
08/21/2013
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