Healthcare Provider Details

I. General information

NPI: 1245416064
Provider Name (Legal Business Name): RUTH ANN LAMAR LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 LEMAY FERRY RD
SAINT LOUIS MO
63129-1576
US

IV. Provider business mailing address

7733 FORSYTH BLVD
CLAYTON MO
63105-1817
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-7184
  • Fax:
Mailing address:
  • Phone: 314-863-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number119114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: