MEDICARE: JENN DELF MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2007037087	MO

General Provider Information

NPI Number	:	1245615590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENN DELF MPT

Provider Business Mailing Address
First Line	:	1745 APPLE HILL DR
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-4883
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13610 BARRETT OFFICE DR
Second Line	:	SUITE 210
City	:	BALLWIN
State	:	MO
Zip	:	63021-7816
Country	:	US
Telephone Number	:	314-822-5107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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