Provider Demographics
NPI:1194690263
Name:HORSTMAN, LARAMIE ALEXANDRIA
Entity type:Individual
Prefix:
First Name:LARAMIE
Middle Name:ALEXANDRIA
Last Name:HORSTMAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 UPPER BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6225
Mailing Address - Country:US
Mailing Address - Phone:636-383-8950
Mailing Address - Fax:
Practice Address - Street 1:7601 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5001
Practice Address - Country:US
Practice Address - Phone:314-961-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025032583225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant