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General NPI Number Information
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NPI Number | 1750066833
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Entity Type | Individual
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Provider Name | ALYSA JANKE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 2046 QUEENSBROOKE BLVD STE 101
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City | SAINT PETERS
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State | MO
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Zip | 63376-7852
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Country | US
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Telephone | 636-875-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 120 HILLSIDE CT
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City | STODDARD
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State | WI
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Zip | 54658-9565
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Country | US
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Telephone | 952-843-3096
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | CP049168T
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16382-024
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License Number State | WI
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