PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC (NPI# 1942524087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942524087 |
| Entity Type | Organization |
| Organization Name | PHYSICAL THERAPY SPINE & SPORTS MEDICINE LLC |
| Other Organization Name | CORA PHYSICAL THERAPY - BALLWIN |
| Practice Address |
15425 Manchester Rd Suite 28 Ballwin MO 63011-3077 |
| Mailing Address |
15425 Manchester Rd Ste 28 Ballwin MO 63011-3077 |
| Practice Telephone | 6362206969 |
| Mailing Telephone | 6362206969 |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2019-09-24 |
| Authorized Official Name | BRAD C. ROUSH (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 4192216712 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| CORA Physical Therapy - Ballwin | Doing Business As Name - Organization |
| Street Address |
15425 MANCHESTER RD SUITE 28 |
| City | BALLWIN |
| State | MO |
| Zip Code | 63011-3077 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720063415 | Rene Gassner | Chiropractor | 15425 Manchester Rd, Suite 11, Ballwin, MO 63011-3077 | 2005-12-14 |
| 1447899836 | Jeanine Boain | Pharmacist | 15425 Manchester Rd, Ballwin, MO 63011-3077 | 2020-01-02 |
| 1750930897 | Danielle Alexandria Austin | Physical Therapy Assistant | 15425 Manchester Rd, Ballwin, MO 63011-3077 | 2019-09-11 |
| 1932660024 | Jill Martin | Physical Therapy Assistant | 15425 Manchester Rd, Ballwin, MO 63011-3077 | 2019-03-29 |
| 1437635729 | Kacy Layne Jetton | Pharmacist | 15425 Manchester Rd, Ballwin, MO 63011-3077 | 2018-07-19 |
| 1730665548 | Ravi Dundoo | Pharmacist | 15425 Manchester Rd, Ballwin, MO 63011-3077 | 2018-07-15 |
| 1710426432 | Zachary Boyle | Physical Therapist | 15425 Manchester Rd, Suite 28, Ballwin, MO 63011-3077 | 2017-02-14 |
| 1609286525 | Margaret Bauman | Physical Therapist | 15425 Manchester Rd, Suite 28, Ballwin, MO 63011-3077 | 2014-04-30 |
| 1386069433 | Ryan Knuckles | Physical Therapist | 15425 Manchester Rd, Suite 28, Ballwin, MO 63011-3077 | 2014-02-26 |
| 1760669378 | Ashley Marie Mcfadden | Physical Therapist | 15425 Manchester Rd, Suite 28, Ballwin, MO 63011-3077 | 2008-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205309234 | Heather Renee Leone | Nurse Practitioner | 452 Sovereign Court Suite A, Ballwin, MO 63011 | 2019-01-02 |
| 1538635297 | Jennifer Lea Nicole O'donnell | Registered Nurse | 13861 Manchester Road, Town and Country, MO 63011 | 2018-10-22 |
| 1285127712 | Genevieve Friedmann | Social Worker | 301 Sovereign Ct Ste 103, Ballwin, MO 63011 | 2018-06-09 |
| 1881187391 | Andrew Cittadino Link | Dentist | 14335 Manchester Road, Ballwin, MO 63011 | 2018-06-08 |
| 1972041283 | Anavan LLC | Durable Medical Equipment & Medical Supplies | 14390 Manchester Rd, Saint Louis, MO 63011 | 2017-02-07 |
| 1780131300 | Autism and Behavioral Spectrum LLC | Day Training, Developmentally Disabled Services | 14733 Clayton Road, Chesterfield, MO 63011 | 2016-09-01 |
| 1265872964 | Eryn Nichole Miner | Behavioral Analyst | 15834 Clayton Road, Ellisville, MO 63011 | 2013-06-27 |
| 1194168765 | Donna Margaret Carrillo | Developmental Therapist | 15834 Clayton Rd., Ellisville, MO 63011 | 2013-04-12 |
| 1891047486 | Ashley Amanda Battaglia | Chiropractor | 15945 Clayton Rd Ste 230c, Ballwin, MO 63011 | 2012-10-08 |
| 1750658480 | Gary Frank Sobocinski | Pharmacist | 4033 Sovereign Court, Ballwin, MO 63011 | 2011-11-23 |
| Find all providers in zip 63011 | ||||
| Taxonomy Code | 261QR0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407012990 | Sundance Rehabilitation Agency, Inc | Clinic/Center | 14525 Clayton Rd, Apt #410, Ballwin, MO 63011-2764 | 2008-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265073845 | Arnold Physical Therapy & Sports Medicine LLC | Clinic/Center | 9594 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-10-04 |
| 1790326916 | Arnold Physical Therapy & Sports Medicine LLC | Clinic/Center | 11725 Manchester Rd, Des Peres, MO 63131-4616 | 2019-09-30 |
| 1477101376 | Ssm Select Rehab St. Louis, LLC | Clinic/Center | 33 Winfield Plz, Winfield, MO 63389-3451 | 2019-09-04 |
| 1104474006 | Ssm Select Rehab St. Louis, LLC | Clinic/Center | 508 W Veterans Memorial Pkwy, Warrenton, MO 63383-1046 | 2019-09-04 |
| 1497310932 | Select Physical Therapy Holdings, Inc. | Clinic/Center | 201 Highway 34 West, Marble Hill, MO 63764 | 2019-05-09 |
| 1972020394 | Rehab Care Group East, LLC | Clinic/Center | Primrose Retirement Community Jefferson City, 1214 Freedom Boulevard, Jefferson City, MO 65109 | 2017-08-25 |
| 1548715402 | Specialty Rehab & Wellness | Clinic/Center | 3309 Crystal Lake Dr, Festus, Festus, MO 63028-4274 | 2016-08-22 |
| 1679947774 | Elite Physical Therapy of Creve Coeur LLC | Clinic/Center | 12788 Olive Blvd, Creve Coeur, MO 63141-6211 | 2015-11-30 |
| 1922414028 | Prorehab, PC | Clinic/Center | 8023 W Florissant Ave Ste A, Jennings, MO 63136-1448 | 2014-07-09 |
| 1831442540 | Invigorate Rehab Inc | Clinic/Center | 1722 Olive St Ste 201, Saint Louis, MO 63103-1700 | 2012-10-18 |
| Find all providers with the same taxonomy | ||||
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| 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.