Organization
LIFEVISION, INC.
Active
Other names
Physical Therapy Innovations
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ELLEN OPENLANDER P.T. (VICE PRESIDENT)
(314) 984-0068
Entity
Organization
Contact information
Practice address
338 S KIRKWOOD RD, UNIT 104B, SAINT LOUIS, MO 63122-6166
(314) 984-0068
(314) 984-0338
Mailing address
338 S KIRKWOOD RD, UNIT 104B, SAINT LOUIS, MO 63122-6166
(314) 984-0068
(314) 984-0338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
00923
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115373
ANTHEM BLUE CROSS BLUE SH
MO
01
—
5769225
AETNA PROVIDER ID
MO
01
—
64-01386
UNITED HEALTHCARE PROVIDE
MO
Enumeration date
02/28/2007
Last updated
07/09/2008
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