Susan Jane Lagemann, P.T.
Individual provider Active NPI Physical Therapist · Eolia, MO
NPI 1215005772 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215005772
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT109456 (MO)
- Practice address
- 19538 Pike 266
Eolia, MO 63344-4014 - Phone
- (573) 485-6316
- Fax
- (573) 485-6316
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT109456 | MO | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT109456 | MO | Yes |
Addresses
Primary practice location
19538 Pike 266
Eolia, MO 63344-4014
Mailing address
19538 Pike 266
Eolia, MO 63344-4014
Phone (573) 485-6316
Other providers in Eolia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.