Healthcare Provider Details

I. General information

NPI: 1164538716
Provider Name (Legal Business Name): SOUTH ST. LOUIS REHAB INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11628 OLD BALLAS RD
SAINT LOUIS MO
63141-7030
US

IV. Provider business mailing address

11628 OLD BALLAS RD
SAINT LOUIS MO
63141-7030
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-3500
  • Fax: 314-996-3501
Mailing address:
  • Phone: 314-996-3500
  • Fax: 314-996-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. JASON KYLE HUBER
Title or Position: BILLING MANAGER
Credential:
Phone: 314-996-3500