Healthcare Provider Details

I. General information

NPI: 1043652613
Provider Name (Legal Business Name): MARIA KOPFF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10954 KENNERLY RD
SAINT LOUIS MO
63128-2018
US

IV. Provider business mailing address

11094 KOHRS LN
SAINT LOUIS MO
63123-7059
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number109460
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: