Healthcare Provider Details

I. General information

NPI: 1336459494
Provider Name (Legal Business Name): LAURA HOAGLAND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E TERRA LN
O FALLON MO
63366-4414
US

IV. Provider business mailing address

5460 PRECIOUS STONE DR
SAINT CHARLES MO
63304-4575
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-6634
  • Fax:
Mailing address:
  • Phone: 636-352-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2006020238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: