MEDICARE: MRS. LISA ANN PEOPLES PT

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	174400000X	Specialist	01479	MO

General Provider Information

NPI Number	:	1710263108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ANN PEOPLES PT

Provider Business Mailing Address
First Line	:	14219 KINDERHOOK DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2921
Country	:	US
Telephone Number	:	314-878-2196
Fax Number	:

Provider Business Practice Location Address
First Line	:	14219 KINDERHOOK DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2921
Country	:	US
Telephone Number	:	314-878-2196
Fax Number	:

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

Provider Enumeration Date	:	10/29/2011
Last Update Date	:	10/29/2011

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