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General NPI Number Information
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NPI Number | 1982914818
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Entity Type | Organization
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Legal Business Name | ST CLAIR PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 1135 N COMMERCIAL AVE
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City | SAINT CLAIR
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State | MO
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Zip | 63077-1012
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Country | US
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Telephone | 636-629-8110
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | SAINT CLAIR
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State | MO
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Zip | 63077-0365
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KAMIL DOSTALIK
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Credential |
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Telephone | 636-629-8110
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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 | 02070
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License Number State | MO
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