Provider Demographics
NPI:1003842485
Name:REHAB DYNAMICS, INC.
Entity Type:Organization
Organization Name:REHAB DYNAMICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NICEWANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-442-6249
Mailing Address - Street 1:10435 CLAYTON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2909
Mailing Address - Country:US
Mailing Address - Phone:314-442-6249
Mailing Address - Fax:314-787-5949
Practice Address - Street 1:10435 CLAYTON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2909
Practice Address - Country:US
Practice Address - Phone:314-442-6249
Practice Address - Fax:314-787-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO297989OtherGHP
MO5716981OtherFIRST HEALTH
MO211293OtherANTHEM
MO699969OtherUNITEDHEALTHCARE
MO760676OtherHEALTHLINK
MO760676OtherHEALTHLINK