Healthcare Provider Details

I. General information

NPI: 1558284968
Provider Name (Legal Business Name): SACRAL FUNCTION THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SHERRY DR
BELLEVILLE IL
62220-3055
US

IV. Provider business mailing address

5343 BELLEVILLE CROSSING ST # 1023
BELLEVILLE IL
62226-3108
US

V. Phone/Fax

Practice location:
  • Phone: 314-530-9028
  • Fax:
Mailing address:
  • Phone: 425-449-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PEREGRIN DARBY CHAREST
Title or Position: OWNER
Credential: MSOT, TIPHP, CSOT
Phone: 425-449-6454