Basic Information
| Provider Information | |||||||||
| NPI: | 1255772091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WURM | ||||||||
| FirstName: | LACI | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPT, ATC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DURLER | ||||||||
| OtherFirstName: | LACI | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13537 BARRETT PARKWAY DR | ||||||||
| Address2: | STE 105 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630215899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148219126 | ||||||||
| FaxNumber: | 3148219142 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 RECREATION DR | ||||||||
| Address2: | STE 130 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630906107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362399979 | ||||||||
| FaxNumber: | 6362395442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2013028590 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.