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General NPI Number Information
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NPI Number | 1356462493
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S MERCY CHILD DEVELOPMENT CENTER
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 641 N NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6713
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Country | US
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Telephone | 314-872-3345
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Fax | 314-872-3180
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Provider Business Mailing Address
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Address Line | 641 N NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6713
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Country | US
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Telephone | 314-872-3345
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Fax | 314-872-3180
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MIRIAM HELENE RUPP
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Credential | P.T.
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Telephone | 314-872-3345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 2003016370
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License Number State | MO
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