Provider Demographics
NPI:1356503437
Name:FREUND, BRIAN (MSPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FREUND
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 KEATON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8220
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:221 SPENCER RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2438
Practice Address - Country:US
Practice Address - Phone:636-477-9911
Practice Address - Fax:636-477-9929
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150900001Medicare PIN
MO151100001Medicare PIN