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NPI Code Detail

MEDICARE: ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.

MEDICARE: ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistMO

General Provider Information

NPI Number : 1164535217
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.
Provider Business Mailing Address
First Line : 939 HIGHWAY K
Second Line :
City : O FALLON
State : MO
Zip : 63366-2910
Country : US
Telephone Number : 636-240-7000
Fax Number : 636-240-7513
Provider Business Practice Location Address
First Line : 1840 ZUMBEHL RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-2761
Country : US
Telephone Number : 636-947-7678
Fax Number : 636-947-4350
Authorized Official
Title or Position : BUSINESS DIRECTOR
Name : MRS. MONIKA WILSON
Credential :
Telephone Number : 636-240-7000
Provider Enumeration Date : 08/15/2006
Last Update Date : 05/08/2008

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