Basic Information
| Provider Information | |||||||||
| NPI: | 1902022700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAUL LOWRANCE | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | P.T. | ||||||||
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| OtherLastName: | GRAUL | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 823 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | MASCOUTAH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622581720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152902605 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8340 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631472333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143859563 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT0000007392 | TN | N | Other Service Providers | Specialist | 225100000X | 2010028880 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 070009662 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.