Healthcare Provider Details

I. General information

NPI: 1720429558
Provider Name (Legal Business Name): MISSOURI PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9751 CLAYTON RD
SAINT LOUIS MO
63124-1503
US

IV. Provider business mailing address

12961 MAYERLING DR
SAINT LOUIS MO
63146-3601
US

V. Phone/Fax

Practice location:
  • Phone: 314-922-2457
  • Fax:
Mailing address:
  • Phone: 314-922-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2012027772
License Number StateMO

VIII. Authorized Official

Name: DR. KYLE WILLIAM WEINDEL
Title or Position: OWNER
Credential: DPT
Phone: 314-922-2457