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General NPI Number Information
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NPI Number | 1255873204
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Entity Type | Individual
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Provider Name | HOLLY WEBB PTA
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Gender | Female
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 1001 S KIRKWOOD RD SUITE 150
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City | KIRKWOOD
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State | MO
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Zip | 63122-7254
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Country | US
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Telephone | 314-447-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 12380 DEPAUL DRIVE
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-447-9710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2016037532
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License Number State | MO
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