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General NPI Number Information
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NPI Number | 1770514879
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Entity Type | Organization
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Legal Business Name | SPORTS AND PHYSICAL THERAPY CENTER
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 322 N CENTRAL AVE
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City | EUREKA
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State | MO
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Zip | 63025-1826
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Country | US
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Telephone | 636-938-4065
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Fax | 636-938-4067
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Provider Business Mailing Address
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Address Line | 322 N CENTRAL AVE
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City | EUREKA
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State | MO
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Zip | 63025-1826
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Country | US
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Telephone | 636-938-4065
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Fax | 636-938-4067
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SEAN C QUINN
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Credential | PT
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Telephone | 636-938-4065
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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 | 2001005492
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License Number State | MO
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