Healthcare Provider Details

I. General information

NPI: 1477061661
Provider Name (Legal Business Name): EMPOWERME REHABILITATION MO AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 1ST CAPITOL DR
SAINT CHARLES MO
63301-1646
US

IV. Provider business mailing address

120 S CENTRAL AVE STE 1050
SAINT LOUIS MO
63105-1731
US

V. Phone/Fax

Practice location:
  • Phone: 636-255-8652
  • Fax:
Mailing address:
  • Phone: 314-485-7979
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JANAKA DIAS
Title or Position: PRESIDENT
Credential:
Phone: 314-485-7979