Provider Demographics
NPI:1932302676
Name:ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ST. CHARLES SPORTS&PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-240-7000
Mailing Address - Street 1:939 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2910
Mailing Address - Country:US
Mailing Address - Phone:636-240-7000
Mailing Address - Fax:636-240-7513
Practice Address - Street 1:939 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2910
Practice Address - Country:US
Practice Address - Phone:636-240-7000
Practice Address - Fax:636-240-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier