Healthcare Provider Details

I. General information

NPI: 1497980700
Provider Name (Legal Business Name): PENCIL KIDZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 05/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16750 CHESTERFIELD MANOR DR
CHESTERFIELD MO
63005-1647
US

IV. Provider business mailing address

16750 CHESTERFIELD MANOR DR
CHESTERFIELD MO
63005-1647
US

V. Phone/Fax

Practice location:
  • Phone: 636-346-6488
  • Fax:
Mailing address:
  • Phone: 636-346-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08150
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number08150
License Number StateMO

VIII. Authorized Official

Name: MRS. WENDY SELMAN
Title or Position: PHYSICAL THERAPIST/PRINCIPAL
Credential: PT, CHT
Phone: 636-346-6488