Healthcare Provider Details

I. General information

NPI: 1477791838
Provider Name (Legal Business Name): AT HOME PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HILLSIDE MANOR COURT
ST. PETERS MO
63376-4144
US

IV. Provider business mailing address

34 HILLSIDE MANOR COURT
ST. PETERS MO
63376-4144
US

V. Phone/Fax

Practice location:
  • Phone: 314-922-6844
  • Fax: 636-294-9500
Mailing address:
  • Phone: 314-922-6844
  • Fax: 636-294-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SCOTT GUTSHALL
Title or Position: OWNER
Credential: P.T.
Phone: 314-922-6844