Individual
ANTONIO MAURICIO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
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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