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:
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Other - Credentials:
Mailing Address - Street 1:14825 N OUTER 40 RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:314-336-2555
Mailing Address - Fax:866-276-7023
Practice Address - Street 1:14825 N OUTER 40 RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2555
Practice Address - Fax:866-276-7023
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
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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