MEDICARE: MISSOURI LUNA CARE PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1780265934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI LUNA CARE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 290609
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37229-0609
Country	:	US
Telephone Number	:	866-525-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 S BEMISTON AVE STE 800
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-1925
Country	:	US
Telephone Number	:	866-806-3599
Fax Number	:

Authorized Official
Title or Position	:	PAYER OPERATIONS SUPERVISOR
Name	:	JASMINE GONZALEZ
Credential	:
Telephone Number	:	916-232-3047

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	02/06/2026

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Directions to “MISSOURI LUNA CARE PHYSICAL THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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