Healthcare Provider Details

I. General information

NPI: 1093045940
Provider Name (Legal Business Name): JENNIFER K REZABEK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER K SCHLICK MPT

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 CHESTERFIELD VALLEY DRIVE
CHESTERFIELD MO
63005-1161
US

IV. Provider business mailing address

15 APEX DR SUITE 105
HIGHLAND IL
62249-1282
US

V. Phone/Fax

Practice location:
  • Phone: 636-812-0094
  • Fax: 636-812-0152
Mailing address:
  • Phone: 618-441-0482
  • Fax: 618-441-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2009037275
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: