Provider Demographics
NPI:1124212816
Name:CVPT-OLIVETTE, LLC
Entity Type:Organization
Organization Name:CVPT-OLIVETTE, LLC
Other - Org Name:ST. LOUIS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MOMT
Authorized Official - Phone:636-728-1777
Mailing Address - Street 1:17300 N OUTER 40
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:636-728-1777
Mailing Address - Fax:
Practice Address - Street 1:2558 GLADIATOR DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2285
Practice Address - Country:US
Practice Address - Phone:636-861-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CVPT-OLIVETTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-05
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty