Provider Demographics
NPI:1386838613
Name:TIEPELMAN, TODD R (PTA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:TIEPELMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-416-0439
Mailing Address - Fax:314-487-3062
Practice Address - Street 1:845 N NEW BALLAS CT
Practice Address - Street 2:SUITE 40
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7134
Practice Address - Country:US
Practice Address - Phone:314-872-1644
Practice Address - Fax:314-872-1801
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO116851225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant