# PHYSICAL THERAPY COLLECTIVE, LLC

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

## Provider details

- **NPI number:** 1699269928
- **Authorized official:** MARY LUCILLE COOLEY DPT (OWNER/ PHYSICAL THERAPIST)
- **Authorized official phone:** (801) 550-0373

## Contact information

- **Practice address:** 4642 SHENANDOAH AVE, SAINT LOUIS, MO 63110-3424
- **Practice address phone:** (314) 664-6400
- **Practice address fax:** (314) 664-6401
- **Mailing address:** 3830 HUMPHREY ST, SAINT LOUIS, MO 63116-4826
- **Mailing address phone:** (801) 550-0373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | LC001588222 | MO | Yes |

## Other

- **Enumeration date:** 06/20/2018
- **Last updated:** 06/20/2018