Provider Demographics
NPI:1083811731
Name:WEST COUNTY PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:WEST COUNTY PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-861-8558
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-0672
Mailing Address - Country:US
Mailing Address - Phone:636-861-8558
Mailing Address - Fax:
Practice Address - Street 1:2007 SMIZER STATION RD
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-2097
Practice Address - Country:US
Practice Address - Phone:636-861-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00006485111NN0400X
MO00996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty