Healthcare Provider Details

I. General information

NPI: 1669484119
Provider Name (Legal Business Name): OLYMPIC REHAB WELLNESS AND PAIN CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/09/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 OLD OLIVE STREET RD STE 305
SAINT LOUIS MO
63141-5914
US

IV. Provider business mailing address

10420 OLD OLIVE STREET RD STE 305
SAINT LOUIS MO
63141-5914
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-1003
  • Fax: 314-455-3469
Mailing address:
  • Phone: 314-849-1003
  • Fax: 314-455-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number111213
License Number StateMO

VIII. Authorized Official

Name: DR. ALEXANDER BEYZER
Title or Position: OWNER
Credential: M.D.
Phone: 314-849-1003