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General NPI Number Information
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NPI Number | 1841390960
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Entity Type | Organization
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Legal Business Name | PREFERRED PT DES PERES LLC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1032 OLD DES PERES RD
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City | DES PERES
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State | MO
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Zip | 63131-1865
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Country | US
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Telephone | 314-821-6181
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Fax | 314-821-6184
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Provider Business Mailing Address
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Address Line | 200 W DOUGLAS AVE STE. 1040
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City | WICHITA
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State | KS
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Zip | 67202-3013
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Country | US
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Telephone | 316-263-0003
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Fax | 316-263-1241
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Authorized Official
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Title or Position | OWNER
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Name | DAVID C TODD
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Credential | P.T.
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Telephone | 316-260-6869
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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 | 2000144114
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License Number State | MO
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