Healthcare Provider Details

I. General information

NPI: 1942088554
Provider Name (Legal Business Name): AUSTIN BUCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 WINGHAVEN BLVD
O FALLON MO
63368-3620
US

IV. Provider business mailing address

14124 STATE HIGHWAY FF
MARBLE HILL MO
63764-4645
US

V. Phone/Fax

Practice location:
  • Phone: 636-265-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2023036682
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: