Healthcare Provider Details

I. General information

NPI: 1457242190
Provider Name (Legal Business Name): SYDNEY JOLIE MCINNIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 08/11/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S LINDBERGH BLVD DEPT PHYSICAL THERAPY
SAINT LOUIS MO
63127-1338
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1940
  • Fax: 314-286-1473
Mailing address:
  • Phone: 314-286-1940
  • Fax: 314-286-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026032991
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: