Healthcare Provider Details

I. General information

NPI: 1407822505
Provider Name (Legal Business Name): SCOTT DANIEL KUGLER ATC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S KIRKWOOD RD
SAINT LOUIS MO
63122-6161
US

IV. Provider business mailing address

10942 PEM RD
SAINT LOUIS MO
63146-5410
US

V. Phone/Fax

Practice location:
  • Phone: 314-909-0517
  • Fax: 314-909-0518
Mailing address:
  • Phone: 314-853-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2007028022
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: