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General NPI Number Information
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NPI Number | 1548855513
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Entity Type | Individual
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Provider Name | JEFFREY JOHN EDDY COF, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 12984 MAURER INDUSTRIAL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1564
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Country | US
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Telephone | 314-842-6750
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Fax | 314-842-6761
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Provider Business Mailing Address
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Address Line | 936 LANDS END CIR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-5018
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Country | US
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Telephone | 636-236-2457
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 00194
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License Number State | MO
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