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General NPI Number Information
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NPI Number | 1598036907
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PHYSICAL AND SPORTS THERAPY LLC
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 1043 WOLFRUM RD
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City | WELDON SPRING
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State | MO
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Zip | 63304-7625
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Country | US
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Telephone | 636-300-4600
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Fax | 636-300-4603
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Provider Business Mailing Address
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Address Line | 1043 WOLFRUM RD
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City | WELDON SPRING
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State | MO
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Zip | 63304-7625
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Country | US
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Telephone | 636-300-4600
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Fax | 636-300-4603
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATRICIA LEE TRACY
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Credential | P.T.
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Telephone | 636-300-4600
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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 | 01952
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License Number State | MO
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