Healthcare Provider Details

I. General information

NPI: 1174449680
Provider Name (Legal Business Name): PEARL PELVIC HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HUNTSDALE DR
WENTZVILLE MO
63385-3235
US

IV. Provider business mailing address

250 HUNTSDALE DR
WENTZVILLE MO
63385-3235
US

V. Phone/Fax

Practice location:
  • Phone: 573-822-3804
  • Fax:
Mailing address:
  • Phone: 573-822-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELLE WATERS
Title or Position: MEMBER
Credential: DPT
Phone: 573-822-3804