Provider Demographics
NPI:1942547716
Name:HAEUSSER, SARAH KEALEY (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KEALEY
Last Name:HAEUSSER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12143 BENT BROOK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2114
Mailing Address - Country:US
Mailing Address - Phone:913-231-3785
Mailing Address - Fax:
Practice Address - Street 1:78 GILLETTE FIELD CLOSE
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-0527
Practice Address - Country:US
Practice Address - Phone:314-517-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110203532251X0800X
KS11-043152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic