Healthcare Provider Details

I. General information

NPI: 1679740971
Provider Name (Legal Business Name): SANDRA KAY HUFFMAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 S LINDBERGH BLVD SUITE A
SAINT LOUIS MO
63125-4200
US

IV. Provider business mailing address

6925 S LINDBERGH BLVD SUITE A
SAINT LOUIS MO
63125-4200
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-8616
  • Fax: 314-894-8633
Mailing address:
  • Phone: 314-894-8616
  • Fax: 314-894-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2000154572
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: