Basic Information
| Provider Information | |||||||||
| NPI: | 1346276607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMATO PHYSICAL THERAPY ASSOCIATES, LLC | ||||||||
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| OtherOrganizationName: | EXCEL SPORTS AND PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11709 OLD BALLAS RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149910480 | ||||||||
| FaxNumber: | 3149910487 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 N NEW BALLAS RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149910480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | LAURENT | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6163565011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 00012 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.