Healthcare Provider Details

I. General information

NPI: 1023948528
Provider Name (Legal Business Name): PARKER RENO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 EXECUTIVE CENTRE PKWY STE 200
SAINT PETERS MO
63376-3809
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 636-255-8750
  • Fax:
Mailing address:
  • Phone: 636-223-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026020774
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: