Healthcare Provider Details

I. General information

NPI: 1316120256
Provider Name (Legal Business Name): RUESCHHOFF PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10712 VETERANS MEMORIAL PKWY
LAKE SAINT LOUIS MO
63367-1469
US

IV. Provider business mailing address

1050 OLD DES PERES RD SUITE 40
SAINT LOUIS MO
63131-1873
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-8514
  • Fax: 636-561-8573
Mailing address:
  • Phone: 314-821-0200
  • Fax: 314-821-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAN RUESCHHOFF
Title or Position: PRESIDENT
Credential:
Phone: 314-821-0200