Healthcare Provider Details

I. General information

NPI: 1255172235
Provider Name (Legal Business Name): CURTIS WELDON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-2228
US

IV. Provider business mailing address

1530 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-2228
US

V. Phone/Fax

Practice location:
  • Phone: 314-669-5006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2023021800
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2023021800
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: