Healthcare Provider Details

I. General information

NPI: 1790983641
Provider Name (Legal Business Name): SARAH AMY WOODRUM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5943 TELEGRAPH RD
SAINT LOUIS MO
63129-4715
US

IV. Provider business mailing address

1445 CLAYTONIA TER
SAINT LOUIS MO
63117-2123
US

V. Phone/Fax

Practice location:
  • Phone: 314-846-2000
  • Fax:
Mailing address:
  • Phone: 314-781-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number105168
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: