Individual
MR. JERRAD LEE BENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, MMP
Contact information
Practice address
2430 TELLICHERRY DR, SAINT LOUIS, MO 63125-3108
(314) 600-6293
Mailing address
2430 TELLICHERRY DR., 300A, SAINT LOUIS, MO 63125-3108
(314) 600-6293
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2001031193
MO
Other
Enumeration date
08/18/2017
Last updated
07/21/2022
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