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General NPI Number Information
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NPI Number | 1487426623
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Entity Type | Organization
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Legal Business Name | VETERANS MEDICAL MASSAGE VMMLLC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 5320 BISCHOFF AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3122
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Country | US
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Telephone | 314-504-2493
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Fax |
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Provider Business Mailing Address
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Address Line | 5320 BISCHOFF AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3122
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Country | US
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Telephone | 314-504-2493
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | GREGORY SMITH
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Credential | LMT
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Telephone | 314-504-2493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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