Most Relevant Information
Provider Data
| NPI Number: | 1003343468 |
| Provider Name: | PRATHIBHA MANNIL |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2017008695 |
Most Important Dates
| Enumeration Date: | 05/17/2017 |
| Last Updated: | 05/17/2017 |
Provider Practice Location
5400 EXECUTIVE CENTRE PKWY
SAINT PETERS
MO
633762594
Practice Location Phone/Fax
| Phone: | 6369227600 |
| Fax: |
Provider Mailing Location
1017 GOLDEN ORCHARD DR
O FALLON
MO
633687990
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |