Healthcare Provider Details

I. General information

NPI: 1689605867
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY & REHAB, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N MOUNT AUBURN RD
CAPE GIRARDEAU MO
63701-2171
US

IV. Provider business mailing address

1405 N MOUNT AUBURN RD STE 400
CAPE GIRARDEAU MO
63701-2171
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-7868
  • Fax:
Mailing address:
  • Phone: 573-335-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number117769
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000355
License Number StateMO

VIII. Authorized Official

Name: DENNIS RINEY
Title or Position: OWNER
Credential: PT
Phone: 573-335-7868