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General NPI Number Information
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NPI Number | 1053593319
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Entity Type | Organization
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Legal Business Name | WASHINGTON UNIVERSITY IN ST. LOUIS
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 1 BROOKINGS DR CAMPUS BOX 1067
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4862
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Country | US
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Telephone | 314-935-6461
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROOKINGS DR CAMPUS BOX 1067
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4862
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Country | US
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Telephone | 314-935-6461
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Fax |
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Authorized Official
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Title or Position | HEAD ATHLETIC TRAINER
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Name | MR. RICK LARSEN
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Credential | L.A.T.
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Telephone | 314-935-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 00062
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License Number State | MO
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