Provider Demographics
NPI:1851497226
Name:SPIELBERG, LAUREN M (MPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:SPIELBERG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:12855 N 40 DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-469-0760
Mailing Address - Fax:314-469-0034
Practice Address - Street 1:12855 N 40 DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:314-469-0760
Practice Address - Fax:314-469-0034
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
220271806Medicare ID - Type Unspecified