MEDICARE: MISSOURI HOME THERAPY LLC

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1164678546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI HOME THERAPY LLC

Provider Business Mailing Address
First Line	:	6746 PAGE AVE STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63133-1616
Country	:	US
Telephone Number	:	314-524-3958
Fax Number	:

Provider Business Practice Location Address
First Line	:	6746 PAGE AVE STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63133-1616
Country	:	US
Telephone Number	:	314-524-3958
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATISHA HOLLOWAY
Credential	:
Telephone Number	:	314-524-3958

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	04/27/2022

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Directions to “MISSOURI HOME THERAPY LLC ” Practice Location

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