Healthcare Provider Details

I. General information

NPI: 1679170930
Provider Name (Legal Business Name): SALVATORE SESTI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2982 HIGHWAY K
O FALLON MO
63368-7861
US

IV. Provider business mailing address

607 DEWEY AVE NW STE 300
GRAND RAPIDS MI
49504-5283
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-5255
  • Fax:
Mailing address:
  • Phone: 616-356-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2020028641
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: