Healthcare Provider Details

I. General information

NPI: 1578763827
Provider Name (Legal Business Name): SIGNATURE HEALTHCARE FOUNDAITON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 LEMAY FERRY RD SUITE 101
SAINT LOUIS MO
63129-1576
US

IV. Provider business mailing address

4850 LEMAY FERRY RD SUITE 101
SAINT LOUIS MO
63129-1576
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-1707
  • Fax: 314-487-3062
Mailing address:
  • Phone: 314-416-0439
  • Fax: 314-487-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number114977
License Number StateMO

VIII. Authorized Official

Name: MRS. ELIZABETH R EARNHART
Title or Position: BUSINESS OFFICE MANGER
Credential:
Phone: 314-416-0439