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General NPI Number Information
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NPI Number | 1760435440
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Entity Type | Organization
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Legal Business Name | PROREHAB PC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15884 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2208
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Country | US
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Telephone | 636-391-5400
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Fax | 636-394-9674
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Provider Business Mailing Address
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Address Line | 13537 BARRETT PARKWAY DR SUITE 105
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City | BALLWIN
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State | MO
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Zip | 63021-5899
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Country | US
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Telephone | 314-821-9126
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Fax | 314-821-9142
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Authorized Official
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Title or Position | A/R MANAGER
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Name | DORENE MACK
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Credential |
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Telephone | 314-238-2209
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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 |
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License Number State |
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