Provider Demographics
NPI:1669916904
Name:SSM PHYSICAL THERAPY
Entity type:Organization
Organization Name:SSM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. GEMME
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:918-520-6126
Mailing Address - Street 1:2532 LEMAY FERRY ROAF
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:61255
Mailing Address - Country:US
Mailing Address - Phone:314-845-0068
Mailing Address - Fax:314-845-0025
Practice Address - Street 1:2532 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3131
Practice Address - Country:US
Practice Address - Phone:314-845-0068
Practice Address - Fax:314-845-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016034461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty