Healthcare Provider Details

I. General information

NPI: 1255772091
Provider Name (Legal Business Name): LACI J WURM DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACI J DURLER

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S HANLEY RD STE 130
SAINT LOUIS MO
63105-2037
US

IV. Provider business mailing address

509 S HANLEY RD
CLAYTON MO
63105-2037
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2013028590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: