Healthcare Provider Details

I. General information

NPI: 1366593766
Provider Name (Legal Business Name): CYNTHIA LYNN BUETER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LINDELL BLVD SUITE 510
SAINT LOUIS MO
63108-3729
US

IV. Provider business mailing address

6012 CAROL ST
HOUSE SPRINGS MO
63051-1432
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-7450
  • Fax:
Mailing address:
  • Phone: 314-471-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2004018039
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: