Healthcare Provider Details

I. General information

NPI: 1013388297
Provider Name (Legal Business Name): MICHAELA R WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3726 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63109-1800
US

IV. Provider business mailing address

790 N HIGHWAY 67 ST
FLORISSANT MO
63031-5108
US

V. Phone/Fax

Practice location:
  • Phone: 314-351-7172
  • Fax: 314-351-6885
Mailing address:
  • Phone: 314-972-1442
  • Fax: 314-972-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2015027150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: