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General NPI Number Information
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NPI Number | 1376001578
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Entity Type | Organization
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Legal Business Name | LOWTWILLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 2323 N MAYFAIR RD STE 104
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City | WAUWATOSA
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State | WI
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Zip | 53226-1506
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Country | US
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Telephone | 262-544-6402
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Fax |
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Provider Business Mailing Address
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Address Line | 4175 CRESCENT DR STE A
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City | SAINT LOUIS
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State | MO
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Zip | 63129-1083
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Country | US
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Telephone | 314-254-2420
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Fax |
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Authorized Official
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Title or Position | CREDENTIALER
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Name | SANDY HARDMAN
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Credential |
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Telephone | 314-254-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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