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General NPI Number Information
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NPI Number | 1255676516
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Entity Type | Individual
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Provider Name | MRS. JANE DIANNE HUELSKOETTER
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Gender | Female
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 13550 S OUTER 40 RD
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-5812
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Country | US
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Telephone | 314-878-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 POLO DOWNS DR
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-8358
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Country | US
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Telephone | 636-891-0075
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 00645
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License Number State | MO
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