Healthcare Provider Details

I. General information

NPI: 1518139542
Provider Name (Legal Business Name): MARY BETH GEHRINGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W SWITZLER ST SUITE 1
CENTRALIA MO
65240-1035
US

IV. Provider business mailing address

201 W SWITZLER ST SUITE 1
CENTRALIA MO
65240-1035
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-5864
  • Fax: 573-682-1544
Mailing address:
  • Phone: 573-682-5864
  • Fax: 573-682-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2007019517
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: