# WINGHAVEN MANUAL PHYSICAL THERAPY

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

## Provider details

- **NPI number:** 1619416567
- **Authorized official:** DANIEL J WASHECK (OWNER, THERAPIST)
- **Authorized official phone:** (636) 625-0408

## Contact information

- **Practice address:** 9 WINGSPAN CT, LAKE SAINT LOUIS, MO 63367-1834
- **Practice address phone:** (636) 699-9357
- **Mailing address:** 21 MEADOWS CIRCLE DR STE 320, LAKE SAINT LOUIS, MO 63367-4110
- **Mailing address phone:** (636) 625-0408
- **Mailing address fax:** (636) 625-0411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | LC001521081 | MO | Yes |

## Other

- **Enumeration date:** 02/13/2017
- **Last updated:** 10/04/2023