Active NPI
Rachel Distelrath
- Physical Therapist
- Creve Coeur, MO
National Provider Identifier
1699885988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 102031
- Practice address
- 12539 Olive Blvd
Creve Coeur, MO 63141-6311 - Phone
- (314) 205-2006
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 102031 | MO | Primary |
Addresses
Primary practice location
12539 Olive Blvd
Creve Coeur, MO 63141-6311
Mailing address
405 Spring Valley CT
Chesterfield, MO 63017-2721
Phone (314) 514-8610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102031 | Other | MO | LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493164800000",
"number": "1699885988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 SPRING VALLEY CT",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630172721",
"telephone_number": "314-514-8610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12539 OLIVE BLVD",
"city": "CREVE COEUR",
"state": "MO",
"postal_code": "631416311",
"telephone_number": "314-205-2006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTELRATH",
"first_name": "RACHEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2017-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "102031",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "102031",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Creve Coeur, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.