Healthcare Provider Details

I. General information

NPI: 1942547716
Provider Name (Legal Business Name): SARAH KEALEY HAEUSSER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 GILLETTE FIELD CLOSE
WELDON SPRING MO
63304-0527
US

IV. Provider business mailing address

12143 BENT BROOK RD STE 100
SAINT LOUIS MO
63122-2114
US

V. Phone/Fax

Practice location:
  • Phone: 314-517-7669
  • Fax:
Mailing address:
  • Phone: 913-231-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2011020353
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11-04315
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: