Healthcare Provider Details

I. General information

NPI: 1730237371
Provider Name (Legal Business Name): LAURIE ANN AUBUCHON R.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 PLAZA DR STE G
SAINT CLAIR MO
63077-1146
US

IV. Provider business mailing address

960 PLAZA DR STE G
SAINT CLAIR MO
63077-1146
US

V. Phone/Fax

Practice location:
  • Phone: 636-629-7778
  • Fax: 636-629-7778
Mailing address:
  • Phone: 636-629-7778
  • Fax: 636-629-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01720
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: