Healthcare Provider Details

I. General information

NPI: 1386416048
Provider Name (Legal Business Name): SPECIALIZED PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 CLARK AVE
SAINT LOUIS MO
63103-2506
US

IV. Provider business mailing address

2840 CLARK AVE
SAINT LOUIS MO
63103-2506
US

V. Phone/Fax

Practice location:
  • Phone: 314-970-2466
  • Fax: 314-949-2523
Mailing address:
  • Phone: 314-970-2466
  • Fax: 314-949-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: POLLY SINHA
Title or Position: OWNER
Credential: PT
Phone: 404-580-8511