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Organization
LEGACY PHYSIATRY GROUP MISSOURI, LLC
Active
Organization
LEGACY PHYSIATRY GROUP MISSOURI, LLC
Active
Parent organization
LEGACY PHYSIATRY GROUP, LLC
Other names
Legacy Physiatry Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEGACY PHYSIATRY GROUP, LLC
Authorized official
DR. VIVEK SASTRY DO (PRESIDENT/CEO)
(972) 372-1663
Entity
Organization
Contact information
Practice address
3636 S GEYER RD, 100, SAINT LOUIS, MO 63127-1237
(972) 372-1663
Mailing address
850 CENTRAL PKWY E, PLANO, TX 75074-5561
(972) 372-1663
(972) 372-1657
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/13/2015
Last updated
04/13/2015
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