Healthcare Provider Details

I. General information

NPI: 1265512206
Provider Name (Legal Business Name): JANET A LEICHT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8228 BRENTWOOD INDUSTRIAL DR
SAINT LOUIS MO
63144-2815
US

IV. Provider business mailing address

13537 BARRETT PARKWAY DR SUITE 105
BALLWIN MO
63021-5899
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-3804
  • Fax: 314-961-1147
Mailing address:
  • Phone: 314-821-9126
  • Fax: 314-821-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1999135157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: