Provider Demographics
NPI:1497919559
Name:LAMEAR, JACQUELINE ANNE (MSPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNE
Last Name:LAMEAR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANNE
Other - Last Name:WOLZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:#1 JEFFERSON BARRACKS DR.
Mailing Address - Street 2:RTE #128 JB
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125
Mailing Address - Country:US
Mailing Address - Phone:314-652-4100
Mailing Address - Fax:314-845-5039
Practice Address - Street 1:1 JEFFERSON BARRACKS DR
Practice Address - Street 2:RTE #128 JB
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-845-5039
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000152718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist