Healthcare Provider Details

I. General information

NPI: 1962016774
Provider Name (Legal Business Name): ENVISION REHAB AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 MEXICO RD STE 102
SAINT PETERS MO
63376-1369
US

IV. Provider business mailing address

7421 MEXICO RD STE 102
SAINT PETERS MO
63376-1369
US

V. Phone/Fax

Practice location:
  • Phone: 636-757-6543
  • Fax: 636-639-4337
Mailing address:
  • Phone: 636-757-6543
  • Fax: 636-639-4337

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

VIII. Authorized Official

Name: KELLY FIALA
Title or Position: DIRECTOR OF INTEGRATED HEALTH SERVI
Credential: MOTR/L
Phone: 636-695-4330