MEDICARE: MISSOURI PHYSICAL 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	261QP2000X	Physical Therapy Clinic/Center	2012027772	MO

General Provider Information

NPI Number	:	1720429558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	12961 MAYERLING DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3601
Country	:	US
Telephone Number	:	314-922-2457
Fax Number	:

Provider Business Practice Location Address
First Line	:	9751 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1503
Country	:	US
Telephone Number	:	314-922-2457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE WILLIAM WEINDEL
Credential	:	DPT
Telephone Number	:	314-922-2457

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	11/05/2014

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