Individual
THERESA PANKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5456 POTOMAC ST, SAINT LOUIS, MO 63139-1547
(636) 577-7260
Mailing address
5456 POTOMAC ST, SAINT LOUIS, MO 63139-1547
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2007018017
MO
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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