Physical Therapy Spine & Sports Medicine LLC
Organization Active NPI Rehabilitation Clinic/Center · St. Peters, MO
NPI 1194454090 · NPPES record last updated Oct 19, 2023
Key facts
- NPI
- 1194454090
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC
- Practice address
- 2046 Queens Brooke Blvd
Suite 101
St. Peters, MO 63376-7852 - Phone
- (419) 221-6717
- Fax
- (419) 222-0507
- NPI assigned
- Jun 7, 2022
- Organization subpart
- No
Authorized official
- Name
- Stephen Krzyminski
- Title
- Senior VP
- Phone
- (419) 221-6717
Other NPIs on the same Medicare enrollment 3
Member of 1
Practitioners 23
-
Alysa Janke, PT, DPT
-
Kinsey Marie Wilson, DPT
-
Jeremiah Blaser, PT, DPT
-
Breland Basler, DPT
-
Jeffrey Goodman, DPT
-
Ryan Kellar, DPT
-
Caitlin Whiteley Lux, PT, DPT
-
Lindsey Norris, DPT
-
Fiona Padrutt, DPT
-
Matthew J Phillips, DPT
-
Erin M Schumer, PT, DPT, GTS
-
Allison Klug, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100503000798 | MO | Part B Supplier - Clinic/Group Practice | 5698803278 |
Receives reassigned benefits from 2 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Arnold, MO; Saint Louis, MO |
| O20100623000778 | MO | Part B Supplier - Clinic/Group Practice | 3173654936 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Saint Peters, MO; Ballwin, MO |
| O20191209000112 | MO | Part a Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 3173654936 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ballwin, MO; Saint Peters, MO |
National Provider Directory
Locations
9594 Manchester Rd
Saint Louis, MO 63119
Phone (314) 274-6314
2046 Queensbrooke Blvd
Ste 101
Saint Peters, MO 63376
Phone (636) 875-7085
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
2046 Queens Brooke Blvd
Suite 101
St. Peters, MO 63376-7852
Mailing address
PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717
Other names
- CORA Physical Therapy - St. Peters
Other providers in St. Peters, MO
- Kathryn Phillippe
- Brittania Rene Phillips
- Heather E Phillips
- Marinda Dawn Phillips
- Gilbert L Phon
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
All providers in St. Peters, MO · Rehabilitation Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.