Healthcare Provider Details

I. General information

NPI: 1841507035
Provider Name (Legal Business Name): THERESA M ESKER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA M WILLIAMS PTA

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 GREEN PARK RD
SAINT LOUIS MO
63123-7211
US

IV. Provider business mailing address

610 PARK ST
WATERLOO IL
62298-1856
US

V. Phone/Fax

Practice location:
  • Phone: 618-977-6704
  • Fax:
Mailing address:
  • Phone: 618-977-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2008003803
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: