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General NPI Number Information
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NPI Number | 1861880361
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Entity Type | Organization
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Legal Business Name | JET THERAPY LLC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 109 N LINCOLN DR STE A
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City | TROY
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State | MO
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Zip | 63379-1426
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Country | US
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Telephone | 636-775-9200
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Fax | 636-775-9201
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Provider Business Mailing Address
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Address Line | 109 N LINCOLN DR STE A
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City | TROY
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State | MO
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Zip | 63379-1426
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Country | US
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Telephone | 636-775-9200
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Fax | 636-775-9201
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUSTIN TEPEN
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Credential |
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Telephone | 636-356-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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