MEDICARE: MRS. SANDRA KAY HUFFMAN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2000154572	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T4781	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1679740971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA KAY HUFFMAN MPT

Provider Business Mailing Address
First Line	:	6925 S LINDBERGH BLVD
Second Line	:	SUITE A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4200
Country	:	US
Telephone Number	:	314-894-8616
Fax Number	:	314-894-8633

Provider Business Practice Location Address
First Line	:	6925 S LINDBERGH BLVD
Second Line	:	SUITE A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-4200
Country	:	US
Telephone Number	:	314-894-8616
Fax Number	:	314-894-8633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	09/30/2010

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