Healthcare Provider Details

I. General information

NPI: 1326984402
Provider Name (Legal Business Name): ANDREW LANGHORST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 FLAMINGO DR
SAINT LOUIS MO
63123-1005
US

IV. Provider business mailing address

85 FLAMINGO DR
SAINT LOUIS MO
63123-1005
US

V. Phone/Fax

Practice location:
  • Phone: 808-238-4988
  • Fax:
Mailing address:
  • Phone: 808-238-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2009037362
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: