Missouri Physical Therapy Services of Creve Coeur, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MISSOURI PHYSICAL THERAPY SERVICES OF CREVE COEUR, LLC

Practice address

1 New Ballas PL
Saint Louis, MO 63146-8700

Phone

(414) 720-1044

Fax

(314) 720-1047

NPI assigned

Mar 21, 2023

Organization subpart

No

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

Authorized official

Name

Joshua L Proffitt

Title

President

Phone

(337) 233-1307

Specialties & licenses 3

Addresses

Other names 1

• Missouri Physical Therapy Services of Creve Coeur Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Fullington, PT, DPT

  • Physical Therapist
  • Saint Louis, MO
  • NPI 1821560467
  Medicare reassignment Care Compare group NPD
• Melani Paull, DPT

  • Physical Therapist
  • Creve Coeur, MO
  • NPI 1205239548
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1679356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1316649544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51266",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705051266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 NEW BALLAS PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631468700",
            "telephone_number": "414-720-1044",
            "fax_number": "314-720-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI PHYSICAL THERAPY SERVICES OF CREVE COEUR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-21",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-233-1307"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Missouri Physical Therapy Services of Creve Coeur",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Missouri Physical Therapy Services of Creve Coeur",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.