Provider Demographics
NPI:1811329709
Name:RICH, PATRICK (PT, DPT, SFMA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:RICH
Suffix:
Gender:M
Credentials:PT, DPT, SFMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8659
Mailing Address - Country:US
Mailing Address - Phone:636-265-1505
Mailing Address - Fax:636-266-2112
Practice Address - Street 1:249 CLARKSON RD STE 101
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011
Practice Address - Country:US
Practice Address - Phone:636-265-1505
Practice Address - Fax:636-266-2112
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014005586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01445568OtherRR MEDICARE
ILF400189131Medicare PIN