Healthcare Provider Details

I. General information

NPI: 1780033969
Provider Name (Legal Business Name): DANIEL SCRIBNER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 BASS PRO DR
SAINT CHARLES MO
63301-2461
US

IV. Provider business mailing address

4273 KEATON CROSSING BLVD
O FALLON MO
63368-8220
US

V. Phone/Fax

Practice location:
  • Phone: 636-757-5075
  • Fax:
Mailing address:
  • Phone: 636-206-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021038885
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2016024410
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: