Provider Demographics
NPI:1528507472
Name:WASHECK MANUAL THERAPY LLC
Entity type:Organization
Organization Name:WASHECK MANUAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WASHECK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:636-699-9357
Mailing Address - Street 1:9 WINGSPAN CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1834
Mailing Address - Country:US
Mailing Address - Phone:636-699-9357
Mailing Address - Fax:
Practice Address - Street 1:3074 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-265-3333
Practice Address - Fax:636-265-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001521104261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy