Healthcare Provider Details

I. General information

NPI: 1164893590
Provider Name (Legal Business Name): KATRINA JUSKENAS DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HARBOR BEND CT
LAKE ST LOUIS MO
63367-1478
US

IV. Provider business mailing address

2 HARBOR BEND CT
LAKE ST LOUIS MO
63367-1478
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-2070
  • Fax:
Mailing address:
  • Phone: 636-695-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2015035613
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: