Provider Demographics
NPI:1548275316
Name:SPORTS ENHANCEMENT GROUP, LLC
Entity type:Organization
Organization Name:SPORTS ENHANCEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:636-728-0889
Mailing Address - Street 1:217 CHESTERFIELD TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1257
Mailing Address - Country:US
Mailing Address - Phone:636-728-0889
Mailing Address - Fax:636-728-1553
Practice Address - Street 1:217 CHESTERFIELD TOWNE CTR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1257
Practice Address - Country:US
Practice Address - Phone:636-728-0889
Practice Address - Fax:636-728-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty