Healthcare Provider Details

I. General information

NPI: 1386556108
Provider Name (Legal Business Name): NEEMA SHABAZZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7361 WATSON RD
SAINT LOUIS MO
63119-4405
US

IV. Provider business mailing address

7361 WATSON RD
SAINT LOUIS MO
63119-4405
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-8020
  • Fax:
Mailing address:
  • Phone: 314-962-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: