Provider Demographics
NPI:1366294639
Name:OPTIMAL MOVEMENT REHABILITATION AND PERFORMANCE
Entity type:Organization
Organization Name:OPTIMAL MOVEMENT REHABILITATION AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STILTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-472-3877
Mailing Address - Street 1:1410 STRASSNER DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1871
Mailing Address - Country:US
Mailing Address - Phone:314-472-3877
Mailing Address - Fax:314-237-1035
Practice Address - Street 1:1410 STRASSNER DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1871
Practice Address - Country:US
Practice Address - Phone:314-472-3877
Practice Address - Fax:314-237-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty