Individual provider Active NPI

Kristen Marie Fallert

  • Physical Therapist
  • Saint Louis, MO
National Provider Identifier
1124457114
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2013028464 Issued in MO
Practice address
1027 Bellevue Ave
Suite 15
Saint Louis, MO 63117-1851
Phone
(314) 768-5375
Fax
(314) 768-5376
NPI assigned
Nov 11, 2013
Last updated
Nov 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070020387 IL
Physical Therapist 225100000X 2013028464 MO Primary

Addresses

Primary practice location

1027 Bellevue Ave
Suite 15
Saint Louis, MO 63117-1851

Mailing address

1027 Bellevue Ave
Suite 15
Saint Louis, MO 63117-1851
Phone (314) 768-5375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251105003226 MO Practitioner - Physical Therapist in Private Practice 4880184191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Medical Group IncGroup PAC ID 4880598291, 40 clinicians

Practice addresses (Care Compare)

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone 31484903112384

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070020387ILMDPhysical Therapist
2013028464MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Medical Group, Inc CurrentSince Nov 1, 2025 Accepting new patients
Signature Medical Group, Inc CurrentSince Nov 1, 2025 Accepting new patients
SSM Rehab Past Accepting new patients

Locations

1895 Richardson Rd
Arnold, MO 63010
Phone (314) 756-2800

12639 Old Tesson Rd
Ste 115
Saint Louis, MO 63128
Phone (314) 842-8655

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1384128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1124457114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 BELLEVUE AVE",
            "address_2": "SUITE 15",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171851",
            "telephone_number": "314-768-5375",
            "fax_number": "314-768-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 BELLEVUE AVE",
            "address_2": "SUITE 15",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171851",
            "telephone_number": "314-768-5375",
            "fax_number": "314-768-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLERT",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-11",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070020387",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2013028464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.