Healthcare Provider Details

I. General information

NPI: 1184459588
Provider Name (Legal Business Name): MEGAN ALICIA GRETZMACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3488 JEFFCO BLVD STE 102
ARNOLD MO
63010-6015
US

IV. Provider business mailing address

604 MONROE ST
DESLOGE MO
63601-3426
US

V. Phone/Fax

Practice location:
  • Phone: 636-464-5439
  • Fax: 636-464-5438
Mailing address:
  • Phone: 573-747-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2024035265
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: