Healthcare Provider Details

I. General information

NPI: 1902272123
Provider Name (Legal Business Name): JOSEPH CALEB STOECKLEIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9437 OLIVE BLVD
OLIVETTE MO
63132-3130
US

IV. Provider business mailing address

1305 RENAISSANCE PL
WELDON SPRING MO
63304-7723
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-9995
  • Fax: 314-989-9500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2015027145
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: