Healthcare Provider Details

I. General information

NPI: 1184834160
Provider Name (Legal Business Name): THC PHYSICAL THERAPY & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 RAYMOND DR
ST. CHARLES MO
63301
US

IV. Provider business mailing address

2621 RAYMOND DR
ST. CHARLES MO
63301
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-2244
  • Fax: 636-946-6975
Mailing address:
  • Phone: 636-946-2244
  • Fax: 636-946-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateMO

VIII. Authorized Official

Name: LINDA L RODDEN
Title or Position: OWNER
Credential:
Phone: 636-946-2244