Healthcare Provider Details

I. General information

NPI: 1508917865
Provider Name (Legal Business Name): LORMAX REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3488 JEFFCO BLVD SUITE 102
ARNOLD MO
63010-6015
US

IV. Provider business mailing address

3488 JEFFCO BLVD SUITE 102
ARNOLD MO
63010-6015
US

V. Phone/Fax

Practice location:
  • Phone: 636-464-5439
  • Fax: 636-464-5438
Mailing address:
  • Phone: 636-464-5439
  • Fax: 636-464-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KAREN LYNN WILD
Title or Position: REGIONAL DIRECTOR
Credential: MPT
Phone: 636-464-5439