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General NPI Number Information
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NPI Number | 1033468301
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Entity Type | Individual
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Provider Name | JACQUELINE KAYE ROSENTHAL MPT
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Gender | Female
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Dates
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Enumeration Date | 09/02/2012
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Last Update Date | 09/02/2012
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Provider Practice Location Address
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Address Line | 3488 JEFFCO BLVD SUITE 102
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City | ARNOLD
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State | MO
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Zip | 63010-6015
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Country | US
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Telephone | 636-464-5439
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WINTER RIVER CT
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City | FENTON
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State | MO
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Zip | 63026-8009
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Country | US
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Telephone | 314-974-5018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2009024428
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License Number State | MO
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