Provider Demographics
NPI:1952069841
Name:KMGP HOLDINGS LLC
Entity type:Organization
Organization Name:KMGP HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ATTEA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:915-603-7070
Mailing Address - Street 1:901 TENLYNN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1250
Mailing Address - Country:US
Mailing Address - Phone:915-603-7070
Mailing Address - Fax:
Practice Address - Street 1:1400 TRIAD CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7351
Practice Address - Country:US
Practice Address - Phone:314-254-2188
Practice Address - Fax:833-638-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty