Healthcare Provider Details

I. General information

NPI: 1376742643
Provider Name (Legal Business Name): CHRISTINE MARIA GRAB LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
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

5943 TELEGRAPH RD
SAINT LOUIS MO
63129-4715
US

V. Phone/Fax

Practice location:
  • Phone: 314-375-1025
  • Fax: 314-846-8944
Mailing address:
  • Phone: 314-375-1025
  • Fax: 314-846-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number116408
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: