PHYSICAL THERAPY COLLECTIVE, LLC (NPI# 1699269928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699269928 |
| Entity Type | Organization |
| Organization Name | PHYSICAL THERAPY COLLECTIVE, LLC |
| Practice Address |
4642 Shenandoah Ave Saint Louis MO 63110-3424 |
| Mailing Address |
3830 Humphrey St Saint Louis MO 63116-4826 |
| Practice Telephone | 3146646400 |
| Practice Fax Number | 3146646401 |
| Mailing Telephone | 8015500373 |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | MARY LUCILLE COOLEY (OWNER/ PHYSICAL THERAPIST) |
| Authorized Official Telephone | 8015500373 |
| Authorized Official Credential | DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
LC001588222 | MO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 161122142605024 | 05 |
| Street Address |
4642 SHENANDOAH AVE |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-3424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558652644 | Pro-motion Pt LLC | Occupational Therapist | 4642 Shenandoah Ave, Saint Louis, MO 63110-3424 | 2011-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053820175 | Prorehab PC | Clinic/Center | 11525 Olde Cabin Rd Ste 1, Saint Louis, MO 63141-7146 | 2017-09-20 |
| 1811447840 | Crystal Cunetto | Clinic/Center | 1114 Ridgelynn Dr, Saint Louis, MO 63124-1220 | 2016-10-13 |
| 1720429558 | Missouri Physical Therapy LLC | Clinic/Center | 9751 Clayton Rd, Saint Louis, MO 63124-1503 | 2013-07-09 |
| 1205067857 | Therapeutic Innovations Lc | Clinic/Center | 563 Cliff Cave Rd, Saint Louis, MO 63129-4415 | 2009-07-30 |
| 1639200074 | Occupational Health Centers of Kansas Pa | Clinic/Center | 1617 S 3rd St, Saint Louis, MO 63104-3839 | 2007-03-08 |
| 1629109087 | Occupational Health Centers of Kansas Pa | Clinic/Center | 8340 N Broadway, Saint Louis, MO 63147-2333 | 2007-03-08 |
| 1194778183 | Prorehab, PC | Clinic/Center | 3726 S Kingshighway Blvd, Saint Louis, MO 63109-1800 | 2006-05-18 |
| 1124071238 | Prorehab, PC | Clinic/Center | 107 Concord Plaza Shopping Ctr, Saint Louis, MO 63128-1307 | 2006-05-18 |
| 1336122266 | Brentwood Physical Therapy Limited | Clinic/Center | 2558 S Brentwood Blvd, Saint Louis, MO 63144-2309 | 2005-11-23 |
| 1518476548 | Prorehab PC | Clinic/Center | 12855 N 40 Dr Ste 375, Saint Louis, MO 63141-8657 | 2017-09-21 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
Please comment or provide details below to improve the information on PHYSICAL THERAPY COLLECTIVE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.