Provider Demographics
NPI:1790856359
Name:INNER CONNECTION INC
Entity Type:Organization
Organization Name:INNER CONNECTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPBURN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LMT
Authorized Official - Phone:314-229-6738
Mailing Address - Street 1:8748 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3730
Mailing Address - Country:US
Mailing Address - Phone:314-918-1555
Mailing Address - Fax:314-918-1541
Practice Address - Street 1:8748 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-3730
Practice Address - Country:US
Practice Address - Phone:314-918-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014021Medicare ID - Type UnspecifiedMC GROUP #