Healthcare Provider Details

I. General information

NPI: 1861450306
Provider Name (Legal Business Name): JOHN ROBERT MOTLEY MSPT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 DUNN RD
FLORISSANT MO
63031
US

IV. Provider business mailing address

3868 MEXICO RD
ST CHARLES MO
63303
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-0442
  • Fax: 314-447-0443
Mailing address:
  • Phone: 636-926-0408
  • Fax: 636-926-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number117648
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: