Healthcare Provider Details

I. General information

NPI: 1902851884
Provider Name (Legal Business Name): THE PHYSICAL THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12048 TESSON FERRY RD
SAINT LOUIS MO
63128-1727
US

IV. Provider business mailing address

12048 TESSON FERRY RD
SAINT LOUIS MO
63128-1727
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-4455
  • Fax: 314-849-2844
Mailing address:
  • Phone: 314-849-4455
  • Fax: 314-849-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateMO

VIII. Authorized Official

Name: LISA M. WHITE
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-849-4455