Colleen Bock, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

115995 Issued in MO

Practice address

7421 Mexico Rd Ste 102
Saint Peters, MO 63376-1369

Phone

(636) 757-6543

Fax

(636) 695-4337

NPI assigned

Jan 11, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Colleen Street Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Envision Rehab and Wellness LLC

  • Physical Therapist
  • Saint Peters, MO
  • NPI 1962016774
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1023607405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7421 MEXICO RD STE 102",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761369",
            "telephone_number": "636-757-6543",
            "fax_number": "636-695-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7421 MEXICO RD STE 102",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761369",
            "telephone_number": "636-757-6543",
            "fax_number": "636-695-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCK",
        "first_name": "COLLEEN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "115995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "STREET",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Blooming Lotus Counseling Services, LLC
• Blue Hayven Foundation
• Venkata KR Bodavula, MD
• William Michael Boedefeld, DDS
• Thomas Samuel Bogusky, D.D.S.
• Zachary Bohr, DPT
• Giuseppi Bommarito Jr. I, ATC, LAT, BS

• Physical Therapy Assistant in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.