Provider Demographics
NPI:1801952577
Name:MYOFASCIAL TREATMENT CENTER LLC
Entity type:Organization
Organization Name:MYOFASCIAL TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-965-4404
Mailing Address - Street 1:10820 SUNSET OFFICE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1029
Mailing Address - Country:US
Mailing Address - Phone:314-965-4404
Mailing Address - Fax:314-965-4464
Practice Address - Street 1:10820 SUNSET OFFICE DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-965-4404
Practice Address - Fax:314-965-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty