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General NPI Number Information
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NPI Number | 1891494472
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Entity Type | Individual
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Provider Name | SAMANTHA JO MERLO DPT
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Gender | Female
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 10859 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2405
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Country | US
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Telephone | 314-521-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1056 SEASONS RIDGE CT
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City | FENTON
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State | MO
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Zip | 63026-3996
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Country | US
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Telephone | 314-365-4636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2023004469
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License Number State | MO
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