1942420948 NPI number — MS. MICHELLE JACQUELINE BRUEGGEMANN MPT

Table of content: MS. MICHELLE JACQUELINE BRUEGGEMANN MPT (NPI 1942420948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942420948 NPI number — MS. MICHELLE JACQUELINE BRUEGGEMANN MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUEGGEMANN
Provider First Name:
MICHELLE
Provider Middle Name:
JACQUELINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SKALA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
JACQUELINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942420948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9437 OLIVE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVETTE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63132-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-989-9500
Provider Business Mailing Address Fax Number:
314-989-9995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17300 N. OUTER 40 RD.
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63005-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-728-1777
Provider Business Practice Location Address Fax Number:
636-728-1793
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2005040725 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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