St. Louis Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

103326 Issued in MO

Legal business name

ST. LOUIS PHYSICAL THERAPY, LLC

Practice address

17300 N Outer 40
Suite 205
Chesterfield, MO 63005-1364

Phone

(636) 728-1777

Fax

(636) 728-1793

NPI assigned

Jul 9, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael J Gorman, PT, MOMT

Title

Owner

Phone

(636) 728-1777

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962435107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40",
            "address_2": "SUITE 205",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-728-1777",
            "fax_number": "636-728-1793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17300 N OUTER 40",
            "address_2": "SUITE 205",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051364",
            "telephone_number": "636-728-1777",
            "fax_number": "636-728-1793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-728-1777",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, MOMT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MO",
            "license": "103326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Physical Therapy Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.