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General NPI Number Information
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NPI Number | 1255772091
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Entity Type | Individual
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Provider Name | LACI J WURM DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 509 S HANLEY RD STE 130
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City | SAINT LOUIS
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State | MO
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Zip | 63105-2037
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Country | US
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Telephone | 314-200-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 509 S HANLEY RD
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City | CLAYTON
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State | MO
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Zip | 63105-2037
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Country | US
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Telephone |
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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 | 2013028590
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License Number State | MO
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