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General NPI Number Information
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NPI Number | 1093697179
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Entity Type | Individual
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Provider Name | LILLIAN GRACE VARNEY
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 1044 N MASON RD STE 220
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City | CREVE COEUR
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State | MO
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Zip | 63141-6689
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Country | US
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Telephone | 314-996-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 295 CRESTFIELD CT
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4938
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Country | US
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Telephone | 317-883-7206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2025923399
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License Number State | MO
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