Healthcare Provider Details

I. General information

NPI: 1730796707
Provider Name (Legal Business Name): SANDRA MARCELLA PARRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13190 S OUTER 40 RD
CHESTERFIELD MO
63017-5917
US

IV. Provider business mailing address

12208 KINGSHILL DR
CREVE COEUR MO
63141-6617
US

V. Phone/Fax

Practice location:
  • Phone: 314-754-2105
  • Fax:
Mailing address:
  • Phone: 314-609-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR0837
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberR0837
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: