Healthcare Provider Details

I. General information

NPI: 1538275151
Provider Name (Legal Business Name): MICHELE BOATRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10859 W FLORISSANT AVE
SAINT LOUIS MO
63136-2405
US

IV. Provider business mailing address

12139 LADUE HEIGHTS DR
SAINT LOUIS MO
63141-6656
US

V. Phone/Fax

Practice location:
  • Phone: 314-521-3000
  • Fax: 314-521-7800
Mailing address:
  • Phone: 314-579-9194
  • 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: