Provider Demographics
NPI:1588973531
Name:SSM PHYSICAL THERAPY
Entity type:Organization
Organization Name:SSM PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHAVEENA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PLUMPE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:314-731-4555
Mailing Address - Street 1:1 VILLAGE SQUARE CTR STE A
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1817
Mailing Address - Country:US
Mailing Address - Phone:314-731-4555
Mailing Address - Fax:
Practice Address - Street 1:1 VILLAGE SQUARE CTR STE
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELELCT MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008030997261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy