Healthcare Provider Details

I. General information

NPI: 1508637596
Provider Name (Legal Business Name): JULIE SCHLOSS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13749 STONEMONT CT
SAINT LOUIS MO
63131-1642
US

IV. Provider business mailing address

13749 STONEMONT CT
SAINT LOUIS MO
63131-1642
US

V. Phone/Fax

Practice location:
  • Phone: 314-413-7628
  • Fax:
Mailing address:
  • Phone: 314-413-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2023006814
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: