Healthcare Provider Details

I. General information

NPI: 1750440889
Provider Name (Legal Business Name): LAURA ALEXANDER O'CONNOR P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3734 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63109-1800
US

IV. Provider business mailing address

13537 BARRETT PARKWAY DR SUITE 105
BALLWIN MO
63021-5899
US

V. Phone/Fax

Practice location:
  • Phone: 314-351-7172
  • Fax: 314-351-6885
Mailing address:
  • Phone: 314-821-9126
  • Fax: 314-821-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2004007310
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: