Provider Demographics
NPI:1740322171
Name:EUBANKS, ANN LOUISE (PT, MHS)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUISE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 LYNDOVER PL
Mailing Address - Street 2:2W
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-2022
Mailing Address - Country:US
Mailing Address - Phone:314-612-0160
Mailing Address - Fax:
Practice Address - Street 1:8747 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3729
Practice Address - Country:US
Practice Address - Phone:314-968-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist