Provider Demographics
NPI:1114357241
Name:REIFSTECK, SARAH E (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:REIFSTECK
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 EMERSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6739
Mailing Address - Country:US
Mailing Address - Phone:314-991-4368
Mailing Address - Fax:314-991-4369
Practice Address - Street 1:633 EMERSON RD STE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-991-4368
Practice Address - Fax:314-991-4369
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960035652255A2300X
MO20130230092255A2300X
MO2016022088363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer