Provider Demographics
NPI:1851574792
Name:RUESCHHOFF PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RUESCHHOFF PHYSICAL THERAPY INC
Other - Org Name:HERITAGE PHYSCIAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUESCHHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-821-0200
Mailing Address - Street 1:1050 OLD DES PERES RD
Mailing Address - Street 2:SUITE 40
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1873
Mailing Address - Country:US
Mailing Address - Phone:314-821-0200
Mailing Address - Fax:314-821-9976
Practice Address - Street 1:104 JUNGERMANN RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1608
Practice Address - Country:US
Practice Address - Phone:636-926-2641
Practice Address - Fax:636-926-3385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUESCHHOFF PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-14
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013979Medicare PIN