Provider Demographics
NPI:1588946909
Name:ELSEA, MARY S (PT)
Entity type:Individual
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First Name:MARY
Middle Name:S
Last Name:ELSEA
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:11709 OLD BALLAS ROAD STE 205
Mailing Address - Street 2:AMATO PHYSCIAL THERAPY
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7076
Mailing Address - Country:US
Mailing Address - Phone:314-991-0483
Mailing Address - Fax:314-991-0487
Practice Address - Street 1:11709 OLD BALLAS ROAD STE 205
Practice Address - Street 2:AMATO PHYSCIAL THERAPY
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7076
Practice Address - Country:US
Practice Address - Phone:314-991-0483
Practice Address - Fax:314-991-0487
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
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Provider Licenses
StateLicense IDTaxonomies
MO01436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist