Healthcare Provider Details

I. General information

NPI: 1902022700
Provider Name (Legal Business Name): STEPHANIE GRAUL LOWRANCE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE M GRAUL P.T.

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 N BROADWAY
SAINT LOUIS MO
63147-2333
US

IV. Provider business mailing address

823 W STATE ST
MASCOUTAH IL
62258-1720
US

V. Phone/Fax

Practice location:
  • Phone: 314-385-9563
  • Fax:
Mailing address:
  • Phone: 615-290-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT0000007392
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010028880
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070009662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: