Organization
PROREHAB PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORENE MACK (A/R MANAGER)
(314) 238-2209
Entity
Organization
Contact information
Practice address
15884 MANCHESTER RD, ELLISVILLE, MO 63011-2208
(636) 391-5400
(636) 394-9674
Mailing address
13537 BARRETT PARKWAY DR, SUITE 105, BALLWIN, MO 63021-5899
(314) 821-9126
(314) 821-9142
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/17/2006
Last updated
08/22/2020
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