Provider Demographics
NPI:1194454090
Name:PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC
Other - Org Name:CORA PHYSICAL THERAPY - ST. PETERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRZYMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-6717
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0150
Mailing Address - Country:US
Mailing Address - Phone:419-221-6717
Mailing Address - Fax:419-222-0507
Practice Address - Street 1:2046 QUEENS BROOKE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7852
Practice Address - Country:US
Practice Address - Phone:419-221-6717
Practice Address - Fax:419-222-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation