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General NPI Number Information
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NPI Number | 1740400779
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Entity Type | Organization
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Legal Business Name | PHYSICAL AND SPORTS THERAPY SERVICES OF ST LOUIS
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 950 FRANCIS PL SUITE 15
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City | SAINT LOUIS
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State | MO
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Zip | 63105-2465
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Country | US
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Telephone | 314-726-1186
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Fax | 314-726-0176
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Provider Business Mailing Address
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Address Line | 950 FRANCIS PL SUITE 15
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City | SAINT LOUIS
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State | MO
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Zip | 63105-2465
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Country | US
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Telephone | 314-726-1186
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Fax | 314-726-0176
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Authorized Official
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Title or Position | OWNER DIRECTOR
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Name | MR. DAN O KELLEY
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Credential | PT DIP MDT
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Telephone | 314-726-1186
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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 | R0063
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License Number State | MO
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