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General NPI Number Information
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NPI Number | 1720028566
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CONSULTANTS, INC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 2865 NETHERTON DR
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City | SAINT LOUIS
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State | MO
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Zip | 63136-4674
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Country | US
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Telephone | 314-653-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 2865 NETHERTON DR
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City | SAINT LOUIS
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State | MO
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Zip | 63136-4674
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Country | US
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Telephone | 314-653-0918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY PEVNICK
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Credential | PT
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Telephone | 314-653-0918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 00394
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License Number State | MO
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