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General NPI Number Information
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NPI Number | 1801419601
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Entity Type | Organization
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Legal Business Name | JUNCTION BRACING & PT
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 4924D SEAN DRIVE
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City | IMPERIAL
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State | MO
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Zip | 63052
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Country | US
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Telephone | 636-224-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 4537 BRIGHTON CT
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City | HIGH RIDGE
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State | MO
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Zip | 63049-3239
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Country | US
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Telephone | 314-265-0033
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE CHRISTINE WATKINS
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Credential | PT
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Telephone | 314-265-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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