Provider Demographics
NPI:1467142885
Name:4HOME PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:4HOME PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLADE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:314-223-4988
Mailing Address - Street 1:2117 HILLSGATE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2210
Mailing Address - Country:US
Mailing Address - Phone:314-223-4988
Mailing Address - Fax:
Practice Address - Street 1:2117 HILLSGATE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-2210
Practice Address - Country:US
Practice Address - Phone:314-223-4988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty