# BACK TO LIFE WELLNESS CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548487671
- **Authorized official:** SHARLENE D SCRUGGS (PRESIDENT)
- **Authorized official phone:** (314) 280-9730

## Contact information

- **Practice address:** 2331 HAMPTON AVE, SAINT LOUIS, MO 63139-2908
- **Practice address phone:** (314) 280-9730
- **Mailing address:** 54 FOUNTAINVEW DR, SAINT CHARLES, MO 63303-3049
- **Mailing address phone:** (314) 280-9730

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 08/22/2020