Provider Demographics
NPI:1922707744
Name:BRUGNARA, TERESA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:BRUGNARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:GRUNDHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5804 WALNUT CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-4500
Mailing Address - Country:US
Mailing Address - Phone:314-303-2068
Mailing Address - Fax:
Practice Address - Street 1:1066 CROSSWINDS CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4836
Practice Address - Country:US
Practice Address - Phone:636-332-5700
Practice Address - Fax:636-332-0822
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist