Provider Demographics
NPI:1578777256
Name:PHYSICAL THERAPY OF FERGUSON-FLORISSANT LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF FERGUSON-FLORISSANT LLC
Other - Org Name:HAND & PHYSICAL THERAPY OF FERGUSON-FLORISSANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-521-3000
Mailing Address - Street 1:10859 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2405
Mailing Address - Country:US
Mailing Address - Phone:314-521-3000
Mailing Address - Fax:314-521-7800
Practice Address - Street 1:10859 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63136-2405
Practice Address - Country:US
Practice Address - Phone:314-521-3000
Practice Address - Fax:314-521-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001758Medicare PIN
MO4673840001Medicare NSC