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NPI Code Detail

MEDICARE: STEPHANIE GRAUL LOWRANCE P.T.

MEDICARE: STEPHANIE GRAUL LOWRANCE 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
1174400000XSpecialistPT0000007392TN
2225100000XPhysical Therapist2010028880MO
3225100000XPhysical Therapist070009662IL

General Provider Information

NPI Number : 1902022700
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GRAUL LOWRANCE P.T.
Provider Business Mailing Address
First Line : 823 W STATE ST
Second Line :
City : MASCOUTAH
State : IL
Zip : 62258-1720
Country : US
Telephone Number : 615-290-2605
Fax Number :
Provider Business Practice Location Address
First Line : 8340 N BROADWAY
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63147-2333
Country : US
Telephone Number : 314-385-9563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 11/08/2010

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