Individual
ANTONIO MAURICIO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3999 HIGHWAY PP, POPLAR BLUFF, MO 63901-9046
(573) 712-2280
Mailing address
PO BOX 3, POPLAR BLUFF, MO 63902-0003
(573) 712-2280
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
R1007
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R1007
MISSOURI LICENSE
MO
Enumeration date
01/14/2019
Last updated
03/30/2021
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