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General NPI Number Information
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NPI Number | 1194518365
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Entity Type | Organization
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Legal Business Name | SAMANTHA CHILSON, LLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 400 LAKE SAINT LOUIS BLVD
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-1377
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Country | US
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Telephone | 636-358-9612
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Fax |
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Provider Business Mailing Address
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Address Line | 142 DIEKAMP LN
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA CHILSON
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Credential |
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Telephone | 636-358-9612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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