Provider Demographics
NPI:1164538716
Name:SOUTH ST. LOUIS REHAB INSTITUTE, INC.
Entity Type:Organization
Organization Name:SOUTH ST. LOUIS REHAB INSTITUTE, INC.
Other - Org Name:WEST COUNTY SPORTS FITNESS & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-3500
Mailing Address - Street 1:11628 OLD BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7030
Mailing Address - Country:US
Mailing Address - Phone:314-996-3500
Mailing Address - Fax:314-996-3501
Practice Address - Street 1:11628 OLD BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7030
Practice Address - Country:US
Practice Address - Phone:314-996-3500
Practice Address - Fax:314-996-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2251X0800X, 225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Multi-Specialty