MEDICARE: MR. JAMES BRANDON REEVES PA-C, MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2001023252	MO
2	363A00000X	Physician Assistant	2021010018	MO

General Provider Information

NPI Number	:	1053444323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES BRANDON REEVES PA-C, MPT

Provider Business Mailing Address
First Line	:	608 OLD ROUTE 66
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-3730
Country	:	US
Telephone Number	:	573-336-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 OLD ROUTE 66
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-3730
Country	:	US
Telephone Number	:	573-336-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/27/2023

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