Organization Name: | MTS-OLIVETTE, LLC |
NPI Number: | 1144460304 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL JUSTIN GORMAN (OWNER/PHYSICAL THERAPIST) |
Mailing Address: | 9437 Olive Blvd Olivette |
State: | MO US |
Postal Code: | 631323130 |
Phone Number: | 3149899500 |
Fax Number: | 3149899995 |
NPI Enumeration Date: | 03/02/2009 |
NPI Last Update Date: | 03/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |