Healthcare Provider Details

I. General information

NPI: 1679947774
Provider Name (Legal Business Name): ELITE PHYSICAL THERAPY OF CREVE COEUR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12788 OLIVE BLVD
CREVE COEUR MO
63141-6211
US

IV. Provider business mailing address

PO BOX 150
LIMA OH
45802-0150
US

V. Phone/Fax

Practice location:
  • Phone: 314-628-1206
  • Fax: 314-628-1208
Mailing address:
  • Phone: 419-221-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN KRZYMINSKI
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-221-6712