Provider Demographics
NPI:1023356474
Name:MHT SENIOR WELLNESS
Entity type:Organization
Organization Name:MHT SENIOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNESHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-524-3958
Mailing Address - Street 1:9191 W FLORISSANT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1424
Mailing Address - Country:US
Mailing Address - Phone:314-524-3958
Mailing Address - Fax:314-524-3959
Practice Address - Street 1:9191 W FLORISSANT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1424
Practice Address - Country:US
Practice Address - Phone:314-524-3958
Practice Address - Fax:314-524-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116922225200000X
MO2008020852225200000X
MO117525225200000X
MO2007006528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty