Healthcare Provider Details

I. General information

NPI: 1598936502
Provider Name (Legal Business Name): TERESA G SEALS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD DES PERES RD
DES PERES MO
63131-1873
US

IV. Provider business mailing address

1050 OLD DES PERES RD
DES PERES MO
63131-1873
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-0200
  • Fax:
Mailing address:
  • Phone: 314-821-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1999140695
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: