Healthcare Provider Details

I. General information

NPI: 1720906175
Provider Name (Legal Business Name): GRACE SKILJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 LANDMARK PARKWAY DR STE 105
SAINT LOUIS MO
63127-1616
US

IV. Provider business mailing address

816 WESTBROOKE MEADOWS CT
BALLWIN MO
63021-7557
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone: 314-682-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026024898
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: