Provider Demographics
NPI:1447478391
Name:O'FALLON PHYSICAL THERAPY AND REHABILITATION
Entity type:Organization
Organization Name:O'FALLON PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-469-9843
Mailing Address - Street 1:226 THF BLVD.
Mailing Address - Street 2:NUMBER 403
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-469-9843
Mailing Address - Fax:314-439-5154
Practice Address - Street 1:226 THF BLVD.
Practice Address - Street 2:NUMBER 403
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-469-9843
Practice Address - Fax:314-439-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004007615225100000X
MO2002018241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty