NPIMap

Organization Active NPI

Physical Therapy Spine & Sports Medicine LLC

Doing business as CORA Physical Therapy - St. Peters

  • Rehabilitation Clinic/Center
  • Saint Peters, MO
National Provider Identifier
1194454090
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC
Doing business as
CORA Physical Therapy - St. Peters
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
Last updated
Oct 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2023

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

Authorized official

Name
Stephen Krzyminski
Title
Senior VP
Phone
(419) 221-6717

Specialties & licenses 1

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

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 1

  • CORA Physical Therapy - St. Peters Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2046 Queensbrooke Blvd
Saint Peters, MO 63376
Phone (636) 875-7075

2046 Queensbrooke Blvd
Ste 101
Saint Peters, MO 63376
Phone (636) 875-7085

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1194454090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020150",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2046 QUEENS BROOKE BLVD",
            "address_2": "SUITE 101",
            "city": "ST. PETERS",
            "state": "MO",
            "postal_code": "633767852",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-07",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "KRZYMINSKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "SENIOR VP",
        "authorized_official_telephone_number": "419-221-6717"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - St. Peters",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CORA Physical Therapy - St. Peters",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Peters, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.