Ellisville Rehab Center, Inc

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

26-6639 Issued in MO

Legal business name

ELLISVILLE REHAB CENTER, INC

Practice address

16075 Manchester Rd
Ellisville, MO 63011-2103

Phone

(636) 256-0880

Fax

(636) 256-9153

NPI assigned

Nov 11, 2010

Organization subpart

No

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

Authorized official

Name

Leslie Anne Siess, D.C,.

Title

Owner

Phone

(636) 256-0880

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289433600000",
    "number": "1104127844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16075 MANCHESTER RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112103",
            "telephone_number": "636-256-0880",
            "fax_number": "636-256-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16075 MANCHESTER RD",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112103",
            "telephone_number": "636-256-0880",
            "fax_number": "636-256-9153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISVILLE REHAB CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-11",
        "last_updated": "2010-11-11",
        "status": "A",
        "authorized_official_last_name": "SIESS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-256-0880",
        "authorized_official_credential": "D.C,."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MO",
            "license": "26-6639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• E. Glenn Glassman, D.D.S. PC Dba Orthocare Systems
• Rachel Edelman
• Renee Ann Eickmeier, M.A., CCC
• Ellisville Chiropractic, Injury and Pain Clinic,LLC
• Ellisville Opco LLC
• Jill Ellsworth, FNP-C
• Empower Her Physical Therapy LLC
• Austin Erker, DC
• Diana Evers, OTR
• Experience Your Greatness

• Exclusive Provider Organization in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Exclusive Provider Organization in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2010; 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.