Healthcare Provider Details

I. General information

NPI: 1619129244
Provider Name (Legal Business Name): ROBERT FRANKLIN LAUTENSCHLEGER ROBERT LAUTENSCHLEGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT LAUTENSCHLEGER PTA

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 WESTLINE INDUSTRIAL DR SUITE 201
SAINT LOUIS MO
63146-3209
US

IV. Provider business mailing address

11960 WESTLINE INDUSTRIAL DR SUITE 201
SAINT LOUIS MO
63146-3209
US

V. Phone/Fax

Practice location:
  • Phone: 314-819-0480
  • Fax: 314-275-7444
Mailing address:
  • Phone: 314-819-0480
  • Fax: 314-275-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number117683
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: