Healthcare Provider Details

I. General information

NPI: 1114357241
Provider Name (Legal Business Name): SARAH E REIFSTECK PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 EMERSON RD STE 100
CREVE COEUR MO
63141-6739
US

IV. Provider business mailing address

633 EMERSON RD STE 100
CREVE COEUR MO
63141-6739
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4368
  • Fax: 314-991-4369
Mailing address:
  • Phone: 314-991-4368
  • Fax: 314-991-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2016022088
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003565
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2013023009
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: