Healthcare Provider Details

I. General information

NPI: 1699904508
Provider Name (Legal Business Name): WHITNEY EMBICK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 FORSYTH BLVD STE 2300
SAINT LOUIS MO
63105-1806
US

IV. Provider business mailing address

7733 FORSYTH BLVD STE 2300
SAINT LOUIS MO
63105-1806
US

V. Phone/Fax

Practice location:
  • Phone: 800-677-1238
  • Fax: 314-846-8944
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2008037344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: