Healthcare Provider Details

I. General information

NPI: 1790749265
Provider Name (Legal Business Name): RACHELLE LANEA STEBE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: RACHELLE LANEA VARBLE ATC

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SPENCER RD SUITE D
ST PETERS MO
63376-2438
US

IV. Provider business mailing address

112 PHYLLISAIRE CT
ST PETERS MO
63376-6553
US

V. Phone/Fax

Practice location:
  • Phone: 636-477-9911
  • Fax:
Mailing address:
  • Phone: 636-577-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2005024099
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: