Provider Demographics
NPI:1962016774
Name:ENVISION REHAB AND WELLNESS LLC
Entity Type:Organization
Organization Name:ENVISION REHAB AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTEGRATED HEALTH SERVI
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALA
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:636-695-4330
Mailing Address - Street 1:7421 MEXICO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1369
Mailing Address - Country:US
Mailing Address - Phone:636-757-6543
Mailing Address - Fax:636-639-4337
Practice Address - Street 1:7421 MEXICO RD STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1369
Practice Address - Country:US
Practice Address - Phone:636-757-6543
Practice Address - Fax:636-639-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-10-30
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