Healthcare Provider Details

I. General information

NPI: 1245433481
Provider Name (Legal Business Name): JUDITH R GELBER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE STE 1212
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

4444 FOREST PARK AVE C B 8502
SAINT LOUIS MO
63108-2212
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1940
  • Fax: 314-286-1473
Mailing address:
  • Phone: 314-286-1940
  • Fax: 314-286-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2007015752
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: