Healthcare Provider Details

I. General information

NPI: 1609340488
Provider Name (Legal Business Name): ALENA PRUEMER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 W MEYER RD
WENTZVILLE MO
63385-3499
US

IV. Provider business mailing address

1428 W MEYER RD
WENTZVILLE MO
63385-3499
US

V. Phone/Fax

Practice location:
  • Phone: 636-887-3660
  • Fax: 636-887-3661
Mailing address:
  • Phone: 636-887-3660
  • Fax: 636-887-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2019000121
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2019004000
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: