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General NPI Number Information
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NPI Number | 1629597000
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Entity Type | Individual
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Provider Name | DANA ROCHELLE BERTUBIN
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Gender | Female
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Dates
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Enumeration Date | 09/16/2017
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Last Update Date | 09/16/2017
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Provider Practice Location Address
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Address Line | 1811 MAPLEWOOD COMMONS DR
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City | MAPLEWOOD
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State | MO
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Zip | 63143-1000
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Country | US
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Telephone | 314-646-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 9 VANMARK WAY
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City | BRENTWOOD
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State | MO
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Zip | 63144-2442
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2009001308
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License Number State | MO
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