Healthcare Provider Details

I. General information

NPI: 1699969964
Provider Name (Legal Business Name): REHAB 1 UNION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 OLD HWY 50 E SUITE 109
UNION MO
63084-3330
US

IV. Provider business mailing address

70 E NORTH ST SUITE 100
EUREKA MO
63025-1205
US

V. Phone/Fax

Practice location:
  • Phone: 636-583-7733
  • Fax: 636-583-7766
Mailing address:
  • Phone: 636-938-4065
  • Fax: 636-938-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2001005492
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. SEAN C QUINN
Title or Position: VICE PRESIDENT
Credential: MPT
Phone: 636-938-4065