Provider Demographics
NPI:1295899722
Name:REHABILITATION PROFESSIONALS INC
Entity type:Organization
Organization Name:REHABILITATION PROFESSIONALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:314-644-1978
Mailing Address - Street 1:1034 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1203
Mailing Address - Country:US
Mailing Address - Phone:314-644-1978
Mailing Address - Fax:314-647-1350
Practice Address - Street 1:950 FRANCIS PL STE 115
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2465
Practice Address - Country:US
Practice Address - Phone:314-916-8751
Practice Address - Fax:314-644-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102882225100000X
MO2005040574225100000X
MOR0877225100000X
MO02232225100000X
MO2006032824225100000X
MO002775225X00000X
MO2004006992235Z00000X
IL146.007307235Z00000X
MO105413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO120047OtherBCBS PROVIDER NUMBER
MO990001493OtherTRICARE PROVIDER NUMBER
MO481617OtherHEALTHLINK PROVIDER NUMBE
MO120764OtherBCBS PROVIDER NUMBER
MO120046OtherBCBS PROVIDER NUMBER
MO650016175Medicare ID - Type UnspecifiedJ. GORDON'S RR MCR ID #
MO120046OtherBCBS PROVIDER NUMBER
MO481617OtherHEALTHLINK PROVIDER NUMBE
MO650016968Medicare ID - Type UnspecifiedD. SIMON'S RR MCR ID #
MO990001493OtherTRICARE PROVIDER NUMBER
MO120764OtherBCBS PROVIDER NUMBER
MO218521493Medicare ID - Type UnspecifiedT. GALLUP RR MEDICARE #
MOCF8606Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #