Healthcare Provider Details

I. General information

NPI: 1942420948
Provider Name (Legal Business Name): MICHELLE JACQUELINE BRUEGGEMANN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MICHELLE JACQUELINE SKALA

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N. OUTER 40 RD. SUITE 205
CHESTERFIELD MO
63005-1364
US

IV. Provider business mailing address

9437 OLIVE BLVD
OLIVETTE MO
63132-3130
US

V. Phone/Fax

Practice location:
  • Phone: 636-728-1777
  • Fax: 636-728-1793
Mailing address:
  • Phone: 314-989-9500
  • Fax: 314-989-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2005040725
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: