NPIMap

Organization Active NPI

Crescent Physical Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Ellisville, MO
National Provider Identifier
1154595122
Registry record updated Apr 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
LC0531406 Issued in MO
Legal business name
CRESCENT PHYSICAL REHABILITATION, LLC
Practice address
1519 Virginia Dr
Ellisville, MO 63011-2046
Phone
(314) 616-1276
NPI assigned
Apr 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2008

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

Authorized official

Name
Mr. Sikander M Bajwa, PT
Title
President
Phone
(314) 616-1276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X LC0531406 MO Primary

Addresses

Primary practice location

1519 Virginia Dr
Ellisville, MO 63011-2046

Mailing address

1519 Virginia Dr
Ellisville, MO 63011-2046
Phone (314) 616-1276

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1208736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208736000000",
    "number": "1154595122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 VIRGINIA DR",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112046",
            "telephone_number": "314-616-1276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 VIRGINIA DR",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112046",
            "telephone_number": "314-616-1276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT PHYSICAL REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-21",
        "last_updated": "2008-04-21",
        "status": "A",
        "authorized_official_last_name": "BAJWA",
        "authorized_official_first_name": "SIKANDER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-616-1276",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "MO",
            "license": "LC0531406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2008; 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.