Organization
SPORTS AND PHYSICAL THERAPY CENTER
Active
Other names
SPTC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN C QUINN PT (PRESIDENT)
(636) 938-4065
Entity
Organization
Contact information
Practice address
322 N CENTRAL AVE, EUREKA, MO 63025-1826
(636) 938-4065
(636) 938-4067
Mailing address
322 N CENTRAL AVE, EUREKA, MO 63025-1826
(636) 938-4065
(636) 938-4067
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2001005492
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11299
ESSENCE
—
01
—
193453
BLUE CROSS BLUE SHIELD
MO
01
—
227075
GHP ADVANTRA CMR
—
01
—
610149300
DEPARTMENT OF LABOR
—
01
—
6400737
UNITED HEALTHCARE
—
01
—
683038
HEALTHLINK
—
01
—
7889614
AETNA
—
01
—
P00158791
MEDICARE RAILROAD
—
Enumeration date
07/06/2006
Last updated
12/04/2013
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