Organization
PHYSICAL THERAPY COLLECTIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LUCILLE COOLEY DPT (OWNER/ PHYSICAL THERAPIST)
(801) 550-0373
Entity
Organization
Contact information
Practice address
4642 SHENANDOAH AVE, SAINT LOUIS, MO 63110-3424
(314) 664-6400
(314) 664-6401
Mailing address
3830 HUMPHREY ST, SAINT LOUIS, MO 63116-4826
(801) 550-0373
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
LC001588222
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161122142605024
—
MO
Enumeration date
06/20/2018
Last updated
06/20/2018
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