# PROREHAB PC

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

## Provider details

- **NPI number:** 1760435440
- **Authorized official:** DORENE MACK (A/R MANAGER)
- **Authorized official phone:** (314) 238-2209

## Contact information

- **Practice address:** 15884 MANCHESTER RD, ELLISVILLE, MO 63011-2208
- **Practice address phone:** (636) 391-5400
- **Practice address fax:** (636) 394-9674
- **Mailing address:** 13537 BARRETT PARKWAY DR, SUITE 105, BALLWIN, MO 63021-5899
- **Mailing address phone:** (314) 821-9126
- **Mailing address fax:** (314) 821-9142

## Taxonomy

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

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 08/22/2020