NPIMap

Organization Active NPI

Elite Physical Therapy of Creve Coeur LLC

Doing business as CORA Physical Therapy - Creve Coeur

  • Rehabilitation Clinic/Center
  • Creve Coeur, MO
National Provider Identifier
1679947774
Registry record updated Oct 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
ELITE PHYSICAL THERAPY OF CREVE COEUR LLC
Doing business as
CORA Physical Therapy - Creve Coeur
Practice address
12788 Olive Blvd
Creve Coeur, MO 63141-6211
Phone
(314) 628-1206
Fax
(314) 628-1208
NPI assigned
Nov 30, 2015
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
Executive Vice President
Phone
(419) 221-6712

Specialties & licenses 1

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

Addresses

Primary practice location

12788 Olive Blvd
Creve Coeur, MO 63141-6211

Mailing address

PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717

Other names 1

  • CORA Physical Therapy - Creve Coeur Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191209000314 MO Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7719280841 Practice locations: Creve Coeur, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679947774. Details of each certification follow.

  • CCN 266690 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 266690

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CORA PHYSICAL THERAPY-CREVE COEUR
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jul 8, 2020
Last certification
Jul 8, 2020
Ownership / control type
Proprietary
Facility address
12788 Olive Boulevard
Creve Coeur, MO 63141

National Provider Directory

National Provider Directory

Member of 2

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

Locations

12788 Olive Blvd
Creve Coeur, MO 63141
Phone (314) 628-1206

Practitioners & affiliated clinicians

Practitioners 105

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 105

NPI Registry JSON

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

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1679947774",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12788 OLIVE BLVD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416211",
            "telephone_number": "314-628-1206",
            "fax_number": "314-628-1208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PHYSICAL THERAPY OF CREVE COEUR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "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": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "419-221-6712"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Creve Coeur",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Creve Coeur, MO

Sources for this page

Verify at the official NPI Registry.