Provider Demographics
NPI:1649313594
Name:ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRESIDENT, AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:BRADEN
Authorized Official - Last Name:BRASFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, OCS
Authorized Official - Phone:314-894-9008
Mailing Address - Street 1:2716 TELEGRAPH RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4078
Mailing Address - Country:US
Mailing Address - Phone:314-894-9008
Mailing Address - Fax:314-894-1232
Practice Address - Street 1:2716 TELEGRAPH RD
Practice Address - Street 2:SUITE #107
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4078
Practice Address - Country:US
Practice Address - Phone:314-894-9008
Practice Address - Fax:314-894-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPT118376261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2249965OtherFIRST HEALTH PROVIDER
MO31288OtherBC - BS CLINIC NUMBER
MO29153OtherCOVENTRY
MO2249965OtherFIRST HEALTH PROVIDER