Basic Information
Provider Information
NPI: 1124418603
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNAPP
FirstName: LINDSEY
MiddleName: SUMNER
NamePrefix: MS.
NameSuffix:  
Credential: ATC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 740 BERRYWINE LN
Address2:  
City: ARNOLD
State: MO
PostalCode: 630104739
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 633 EMERSON RD STE 20
Address2:  
City: CREVE COEUR
State: MO
PostalCode: 631416739
CountryCode: US
TelephoneNumber: 3143253068
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/04/2015
LastUpdateDate: 05/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2255A2300X2016024408MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer

No ID Information.


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