Healthcare Provider Details

I. General information

NPI: 1912032863
Provider Name (Legal Business Name): LORI L GASKELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12430 TESSON FERRY RD STE 352
SAINT LOUIS MO
63128-2702
US

IV. Provider business mailing address

8715 SILVER RD
OTTERVILLE MO
65348-2205
US

V. Phone/Fax

Practice location:
  • Phone: 866-495-5437
  • Fax: 866-495-2445
Mailing address:
  • Phone: 660-366-4623
  • Fax: 866-495-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number108122
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: