Provider Demographics
NPI:1881079549
Name:WORTHINGTON, ANNA (DPT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1223
Mailing Address - Country:US
Mailing Address - Phone:314-644-1978
Mailing Address - Fax:314-644-5730
Practice Address - Street 1:28 WHITE BRIDGE PIKE STE 206
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1467
Practice Address - Country:US
Practice Address - Phone:615-356-9935
Practice Address - Fax:615-746-1614
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0044631Medicaid