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General NPI Number Information
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NPI Number | 1689877896
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S MERCY MEDICAL CENTER
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 HAZELWEST DR STE 200
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City | HAZELWOOD
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State | MO
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Zip | 63042-1754
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Country | US
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Telephone | 314-919-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 1185 SAINT MATTHEW DR
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City | FLORISSANT
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State | MO
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Zip | 63031-7740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MS. RHEA HENDERSON
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Credential | PTA
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Telephone | 314-919-2727
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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 | 1999137877
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License Number State | MO
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