Healthcare Provider Details

I. General information

NPI: 1184534935
Provider Name (Legal Business Name): RESTORE 360 PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 CLEARVIEW RD
UNION MO
63084-3107
US

IV. Provider business mailing address

4825 DOOR FORD RD
BEAUFORT MO
63013-1717
US

V. Phone/Fax

Practice location:
  • Phone: 636-628-2425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN BRUEGGEMANN
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: MPT
Phone: 314-623-5161