MEDICARE: MRS. LAURA ALEXANDER O'CONNOR P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2004007310	MO

General Provider Information

NPI Number	:	1750440889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ALEXANDER O'CONNOR P.T.

Provider Business Mailing Address
First Line	:	13537 BARRETT PARKWAY DR
Second Line	:	SUITE 105
City	:	BALLWIN
State	:	MO
Zip	:	63021-5899
Country	:	US
Telephone Number	:	314-821-9126
Fax Number	:	314-821-9142

Provider Business Practice Location Address
First Line	:	3734 S KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1800
Country	:	US
Telephone Number	:	314-351-7172
Fax Number	:	314-351-6885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/15/2013

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