MEDICARE: INNER CONNECTION 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790856359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER CONNECTION INC

Provider Business Mailing Address
First Line	:	8748 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	314-918-1555
Fax Number	:	314-918-1541

Provider Business Practice Location Address
First Line	:	8748 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	314-918-1555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON HEPBURN
Credential	:	PT, LMT
Telephone Number	:	314-229-6738

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	01/07/2014

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Directions to “INNER CONNECTION INC ” Practice Location

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