Provider Demographics
NPI:1942420948
Name:BRUEGGEMANN, MICHELLE JACQUELINE (MPT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JACQUELINE
Last Name:BRUEGGEMANN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:JACQUELINE
Other - Last Name:SKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9437 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3130
Mailing Address - Country:US
Mailing Address - Phone:314-989-9500
Mailing Address - Fax:314-989-9995
Practice Address - Street 1:17300 N. OUTER 40 RD.
Practice Address - Street 2:SUITE 205
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:636-728-1777
Practice Address - Fax:636-728-1793
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005040725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
224035218Medicare PIN