Doctor Name: | GINA MARIE MYDLO |
NPI Number: | 1841623071 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 213028599 |
Business Practice Address: | 15834 Clayton Rd Ellisville, MO - 630112212 |
Business Phone Number: | 6362272339 |
Business Fax Number: | 6362278711 |
Mailing Address: | 15834 Clayton Rd, ELLISVILLE |
State: | MO |
Postal Code: | 630112212 |
Phone Number: | 6362272339 |
Fax Number: | 6362278711 |
NPI Enumeration Date: | 08/12/2013 |
NPI Last Update Date: | 02/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 213028599 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |