Healthcare Provider Details

I. General information

NPI: 1770557431
Provider Name (Legal Business Name): THE REHABILITATION INSTITUTE OF ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 DUNCAN AVE
SAINT LOUIS MO
63110-1111
US

IV. Provider business mailing address

9001 LIBERTY PKWY
BIRMINGHAM AL
35242-7509
US

V. Phone/Fax

Practice location:
  • Phone: 314-658-3800
  • Fax: 314-534-1132
Mailing address:
  • Phone: 205-967-7116
  • Fax: 205-969-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number467-3
License Number StateMO

VIII. Authorized Official

Name: ROBERT W MCCALLUUM
Title or Position: VICE PRESIDENT
Credential:
Phone: 205-970-5669