1356545750 NPI number — ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.

Table of content: (NPI 1356545750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356545750 NPI number — ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356545750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
939 HIGHWAY K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63366-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-240-7000
Provider Business Mailing Address Fax Number:
636-240-7513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 ZUMBEHL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63303-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-947-7678
Provider Business Practice Location Address Fax Number:
636-947-4350
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
MONIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS DIRECTOR
Authorized Official Telephone Number:
636-240-7000

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com