Provider Demographics
NPI:1881967214
Name:ROSCHNAFSKY, SASHA E (DPT)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:E
Last Name:ROSCHNAFSKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:E
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:13537 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5899
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:784 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7726
Practice Address - Country:US
Practice Address - Phone:636-349-8060
Practice Address - Fax:636-349-9171
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012004504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150900051Medicare PIN