Healthcare Provider Details

I. General information

NPI: 1063323988
Provider Name (Legal Business Name): MARY MCPHEETERS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY LESLEY HUFFMAN-MCPHEETERS- MADILL

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 FIRST CAPITAL DRIVE
ST CHARLES MO
63301
US

IV. Provider business mailing address

213 CYNTHIA DRIVE
TRUESDALE MO
63380
US

V. Phone/Fax

Practice location:
  • Phone: 636-219-4223
  • Fax:
Mailing address:
  • Phone: 636-219-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2017000582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: