Healthcare Provider Details

I. General information

NPI: 1629022256
Provider Name (Legal Business Name): FENTON PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BILTMORE DR SUITE 403
FENTON MO
63026-4641
US

IV. Provider business mailing address

400 BILTMORE DR SUITE 403
FENTON MO
63026-4641
US

V. Phone/Fax

Practice location:
  • Phone: 636-343-0350
  • Fax: 636-343-3519
Mailing address:
  • Phone: 636-343-0350
  • Fax: 636-343-3519

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. GARY E. MEIER
Title or Position: DIRECTOR OF CLINIC AND P.T.
Credential: P.T.
Phone: 636-343-0350