Healthcare Provider Details

I. General information

NPI: 1124418603
Provider Name (Legal Business Name): LINDSEY SUMNER KNAPP ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 EMERSON RD STE 20
CREVE COEUR MO
63141-6739
US

IV. Provider business mailing address

740 BERRYWINE LN
ARNOLD MO
63010-4739
US

V. Phone/Fax

Practice location:
  • Phone: 314-325-3068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2016024408
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: