Healthcare Provider Details

I. General information

NPI: 1902188287
Provider Name (Legal Business Name): RELIANT CARE REHABILITATIVE SERVICES L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CORONA RD SUITE 301
COLUMBIA MO
65203-2548
US

IV. Provider business mailing address

2011 CORONA RD SUITE 301
COLUMBIA MO
65203-2548
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-3860
  • Fax: 314-272-0343
Mailing address:
  • Phone: 314-543-3860
  • Fax: 314-272-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD J DESTEFANE
Title or Position: PRESIDENT
Credential:
Phone: 314-543-3800