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General NPI Number Information
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NPI Number | 1649313594
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2716 TELEGRAPH RD SUITE #107
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4078
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Country | US
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Telephone | 314-894-9008
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Fax | 314-894-1232
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Provider Business Mailing Address
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Address Line | 2716 TELEGRAPH RD SUITE #107
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4078
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Country | US
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Telephone | 314-894-9008
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Fax | 314-894-1232
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Authorized Official
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Title or Position | DIRECTOR, PRESIDENT, AND CEO
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Name | MR. EARL BRADEN BRASFIELD
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Credential | M.S.P.T., O.C.S.
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Telephone | 314-894-9008
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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 | PT118376
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License Number State | MO
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