Healthcare Provider Details

I. General information

NPI: 1730301359
Provider Name (Legal Business Name): TRANSFIGURATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11247 MANCHESTER RD.
KIRKWOOD MO
63122
US

IV. Provider business mailing address

11247 MANCHESTER RD.
KIRKWOOD MO
63122
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-6006
  • Fax: 314-821-6005
Mailing address:
  • Phone: 314-821-6006
  • Fax: 314-821-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR0391
License Number StateMO

VIII. Authorized Official

Name: DEB LAVENDER
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: P.T.
Phone: 314-821-6006