=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558284968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACRAL FUNCTION THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SHERRY DR
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62220-3055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-530-9028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5343 BELLEVILLE CROSSING ST # 1023
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-449-6454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PEREGRIN DARBY CHAREST
-----------------------------------------------------
Credential | MSOT, TIPHP, CSOT
-----------------------------------------------------
Telephone | 425-449-6454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------