Healthcare Provider Details

I. General information

NPI: 1568484681
Provider Name (Legal Business Name): SOUTH ST. LOUIS REHABILITATION INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 KENRICK PLZ
SAINT LOUIS MO
63119-4414
US

IV. Provider business mailing address

78 KENRICK PLZ
SAINT LOUIS MO
63119-4414
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-8020
  • Fax: 314-962-6570
Mailing address:
  • Phone: 314-962-8020
  • Fax: 314-962-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM P HOPFINGER
Title or Position: PRESIDENT
Credential: PT
Phone: 314-962-8020