Provider Demographics
NPI:1750507869
Name:PHYSICAL THERAPY AND REHABILITATION OF MARYLAND HEIGHTS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND REHABILITATION OF MARYLAND HEIGHTS
Other - Org Name:PT AND REHAB OF MARYLAND HEIGHTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-469-9843
Mailing Address - Street 1:36 FOUR SEASONS CENTER
Mailing Address - Street 2:NUMBER 134
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-469-9873
Mailing Address - Fax:314-439-5154
Practice Address - Street 1:36 FOUR SEASONS CENTER
Practice Address - Street 2:NUMBER 134
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-469-9873
Practice Address - Fax:314-439-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty