Healthcare Provider Details

I. General information

NPI: 1538498225
Provider Name (Legal Business Name): BARBARA JEAN MAGRUDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 S KIRKWOOD RD
SAINT LOUIS MO
63122-6169
US

IV. Provider business mailing address

439 S KIRKWOOD RD
SAINT LOUIS MO
63122-6169
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-6285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: