Provider Demographics
NPI:1629022256
Name:FENTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FENTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC AND P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:636-343-0350
Mailing Address - Street 1:400 BILTMORE DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4641
Mailing Address - Country:US
Mailing Address - Phone:636-343-0350
Mailing Address - Fax:636-343-3519
Practice Address - Street 1:400 BILTMORE DR
Practice Address - Street 2:SUITE 403
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4641
Practice Address - Country:US
Practice Address - Phone:636-343-0350
Practice Address - Fax:636-343-3519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy