Healthcare Provider Details

I. General information

NPI: 1194690263
Provider Name (Legal Business Name): LARAMIE ALEXANDRIA HORSTMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 WATSON RD
SAINT LOUIS MO
63119-5001
US

IV. Provider business mailing address

2941 UPPER BOTTOM RD
SAINT CHARLES MO
63303-6225
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-8000
  • Fax:
Mailing address:
  • Phone: 636-383-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2025032583
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: