Healthcare Provider Details

I. General information

NPI: 1114143229
Provider Name (Legal Business Name): LISA MARIE BUERGLER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 BORMAN DR STE 280
SAINT LOUIS MO
63146-4199
US

IV. Provider business mailing address

8 THE BOULEVARD APT. 307
RICHMOND HEIGHTS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 866-433-9555
  • Fax:
Mailing address:
  • Phone: 314-565-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2006011311
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: