Healthcare Provider Details

I. General information

NPI: 1083149686
Provider Name (Legal Business Name): ANTHONY S POPE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 KEATON CROSSING BLVD
O FALLON MO
63368-8220
US

IV. Provider business mailing address

647 SPIRIT AIRPARK WEST DR STE 101
CHESTERFIELD MO
63005-1032
US

V. Phone/Fax

Practice location:
  • Phone: 636-206-6540
  • Fax:
Mailing address:
  • Phone: 636-223-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2017026988
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: