# ST. LOUIS PHYSICAL THERAPY, LLC

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

## Provider details

- **NPI number:** 1962435107
- **Authorized official:** MR. MICHAEL J GORMAN PT, MOMT (OWNER)
- **Authorized official phone:** (636) 728-1777

## Contact information

- **Practice address:** 17300 N OUTER 40, SUITE 205, CHESTERFIELD, MO 63005-1364
- **Practice address phone:** (636) 728-1777
- **Practice address fax:** (636) 728-1793
- **Mailing address:** 17300 N OUTER 40, SUITE 205, CHESTERFIELD, MO 63005-1364
- **Mailing address phone:** (636) 728-1777
- **Mailing address fax:** (636) 728-1793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 103326 | MO | Yes |

## Other

- **Enumeration date:** 07/09/2006
- **Last updated:** 08/22/2020