Individual
IAN LEI MODDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
11365 DORSETT RD, MARYLAND HEIGHTS, MO 63043-3411
(314) 872-6400
Mailing address
409 W ARGONNE DR, SAINT LOUIS, MO 63122-4133
(314) 623-5017
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
MO
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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