Healthcare Provider Details

I. General information

NPI: 1790264448
Provider Name (Legal Business Name): JOSEPH MURPHY-BAUM DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N 7TH ST
SAINT LOUIS MO
63101-2304
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 314-678-1008
  • Fax:
Mailing address:
  • Phone: 630-590-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60878362
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2020007692
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: