Healthcare Provider Details

I. General information

NPI: 1871747196
Provider Name (Legal Business Name): JEFFREY J HUNTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 WENTZVILLE PKWY
WENTZVILLE MO
63385-3817
US

IV. Provider business mailing address

1348 BASS PRO DR
SAINT CHARLES MO
63301-2461
US

V. Phone/Fax

Practice location:
  • Phone: 636-327-7110
  • Fax: 636-327-7135
Mailing address:
  • Phone: 630-575-1980
  • Fax: 314-821-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number113820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: