Provider Demographics
NPI:1265562565
Name:NORTH COUNTY SPORTS FITNESS & REHABILITATION
Entity type:Organization
Organization Name:NORTH COUNTY SPORTS FITNESS & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-895-4664
Mailing Address - Street 1:6308 HAZELWEST CT
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1739
Mailing Address - Country:US
Mailing Address - Phone:314-895-4664
Mailing Address - Fax:314-731-2340
Practice Address - Street 1:6308 HAZELWEST CT
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1739
Practice Address - Country:US
Practice Address - Phone:314-895-4664
Practice Address - Fax:314-731-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier