Healthcare Provider Details

I. General information

NPI: 1356545750
Provider Name (Legal Business Name): ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 ZUMBEHL RD
SAINT CHARLES MO
63303-2761
US

IV. Provider business mailing address

939 HIGHWAY K
O FALLON MO
63366-2910
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-7678
  • Fax: 636-947-4350
Mailing address:
  • Phone: 636-240-7000
  • Fax: 636-240-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. MONIKA WILSON
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 636-240-7000