Healthcare Provider Details

I. General information

NPI: 1154661627
Provider Name (Legal Business Name): ANDREW S BUELOW DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14450 SOUTH OUTER 40 RD
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

14450 SOUTH OUTER 40 RD
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-6060
  • Fax: 314-434-6066
Mailing address:
  • Phone: 314-434-6060
  • Fax: 314-434-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2012038688
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: