Provider Demographics
NPI:1952633786
Name:EASTER, REUBEN ARVELL III (LMT)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:ARVELL
Last Name:EASTER
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SAINT BRENDAN LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6902
Mailing Address - Country:US
Mailing Address - Phone:314-839-0595
Mailing Address - Fax:
Practice Address - Street 1:630 SAINT BRENDAN LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6902
Practice Address - Country:US
Practice Address - Phone:314-839-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT980657983225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist