Individual
MR. JEROME GERONGCO CANAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
407 YALE ST, MEXICO, MO 65265-2340
(925) 285-4422
Mailing address
407 YALE ST, MEXICO, MO 65265-2340
(925) 285-4422
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2005040393
MO
Other
Enumeration date
02/08/2008
Last updated
02/08/2008
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