Provider Demographics
NPI:1194924597
Name:WAUGH, DEBORAH LEE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:WAUGH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
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Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:314-863-7422
Mailing Address - Fax:314-863-0769
Practice Address - Street 1:322 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63021-5917
Practice Address - Country:US
Practice Address - Phone:636-449-1668
Practice Address - Fax:636-527-9543
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001027317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist