Provider Demographics
NPI:1306183223
Name:PHYSICAL THERAPY SPECIALISTS IN NEUROLOGY AND ORTHOPEDICS PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS IN NEUROLOGY AND ORTHOPEDICS PC
Other - Org Name:PHYSICAL THERAPY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:TENHULA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-726-1186
Mailing Address - Street 1:643 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1312
Mailing Address - Country:US
Mailing Address - Phone:636-561-2152
Mailing Address - Fax:
Practice Address - Street 1:950 FRANCIS PL
Practice Address - Street 2:SUITE 15
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2465
Practice Address - Country:US
Practice Address - Phone:314-726-1186
Practice Address - Fax:314-726-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0363261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025074Medicare UPIN