| |
3808 S Lindbergh Blvd, Suite 105, Saint Louis, MO 63127-1367 | |
(314) 843-7800 | |
(314) 843-7804 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 3808 S Lindbergh Blvd, Saint Louis, Missouri |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1801984810 | NPI | - | NPPES |
186721 | Other | MO | BCBS GROUP PROVIDER NUMBE |
656018 | Other | MO | HEALTHLINK GROUP PROVIDER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | NONE REQUIRED (Missouri) | Primary |
Mailing Address | Practice Location Address |
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Po Box 7066, Gulfport, MS 39506-7066 Ph: (228) 436-0999 | 3808 S Lindbergh Blvd, Suite 105, Saint Louis, MO 63127-1367 Ph: (314) 843-7800 |