Healthcare Provider Details

I. General information

NPI: 1144492885
Provider Name (Legal Business Name): DIANA ANNETTE AUBUCHON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 FORSYTH BLVD SUITE 2300
CLAYTON MO
63105-1817
US

IV. Provider business mailing address

2842 DARDENNE LINKS DR
DARDENNE PRAIRIE MO
63368-9741
US

V. Phone/Fax

Practice location:
  • Phone: 800-482-3001
  • Fax:
Mailing address:
  • Phone: 636-544-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number115653
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number115653
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: