Healthcare Provider Details

I. General information

NPI: 1215756283
Provider Name (Legal Business Name): ELAINA PEYTON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINA KOCH PT, DPT

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 LEGENDS PKWY STE 157
EUREKA MO
63025
US

IV. Provider business mailing address

1215 KINGS TRAIL LN
FENTON MO
63026-3619
US

V. Phone/Fax

Practice location:
  • Phone: 636-252-4464
  • Fax:
Mailing address:
  • Phone: 940-577-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2024040298
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2024040298
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: