Healthcare Provider Details

I. General information

NPI: 1467394379
Provider Name (Legal Business Name): DINAH WITHERSPOON DPT, PT, MHA, CGCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 DUSTY ROSE DR
O FALLON MO
63368-6879
US

IV. Provider business mailing address

117 DUSTY ROSE DR
O FALLON MO
63368-6879
US

V. Phone/Fax

Practice location:
  • Phone: 636-747-4263
  • Fax: 636-294-6893
Mailing address:
  • Phone: 636-747-4263
  • Fax: 636-294-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number103530
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: