Healthcare Provider Details

I. General information

NPI: 1114012515
Provider Name (Legal Business Name): JULIE CHRISTINE WATKINS PT, DPT, OCS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/09/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OLD BALLAS RD STE 128
CREVE COEUR MO
63141-7070
US

IV. Provider business mailing address

4537 BRIGHTON CT
HIGH RIDGE MO
63049-3239
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-8776
  • Fax: 314-801-8775
Mailing address:
  • Phone: 314-265-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number2001013160
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2004027809
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: