MEDICARE: PREFERRED PT DES PERES 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	225100000X	Physical Therapist	2000144114	MO

General Provider Information

NPI Number	:	1841390960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED PT DES PERES LLC

Provider Business Mailing Address
First Line	:	200 W DOUGLAS AVE
Second Line	:	STE. 1040
City	:	WICHITA
State	:	KS
Zip	:	67202-3013
Country	:	US
Telephone Number	:	316-263-0003
Fax Number	:	316-263-1241

Provider Business Practice Location Address
First Line	:	1032 OLD DES PERES RD
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-1865
Country	:	US
Telephone Number	:	314-821-6181
Fax Number	:	314-821-6184

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID C TODD
Credential	:	P.T.
Telephone Number	:	316-260-6869

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

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Practice Phone: 636-386-9224
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1336144187 — DR. TODD D BAILEY M.D.
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1659377687 — DR. STEPHEN D SCHMIDT M.D.
Practice Location Address:

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1386640316 — DR. GREGORY H SMITH D.O.
Practice Location Address:

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63131-1865

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1588661417 — DR. JAMES EDWARD BENECKE JR. M.D., F.A.C.S.
Practice Location Address:

1010 OLD DES PERES RD
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1326049636 — MICHAEL P. NOGALSKI M.D.
Practice Location Address:

1050 OLD DES PERES RD. , SUITE 100
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1871594184 — WILLIAM B. STRECKER M.D.
Practice Location Address:

1050 OLD DES PERES RD. , SUITE 100
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Practice Phone: 314-569-0612
Practice Fax: 314-966-0664

Directions to “PREFERRED PT DES PERES LLC ” Practice Location

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