Provider Demographics
NPI:1235602251
Name:LEHOUILLIER, GRACE AGNUS (PTA)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:AGNUS
Last Name:LEHOUILLIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 TOM GINNEVER AVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4519
Mailing Address - Country:US
Mailing Address - Phone:636-978-9255
Mailing Address - Fax:
Practice Address - Street 1:1096 TOM GINNEVER AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4519
Practice Address - Country:US
Practice Address - Phone:636-978-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018026138225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant