MEDICARE: JESSIE BRITTON PTA

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	225200000X	Physical Therapy Assistant	2011026829	MO

General Provider Information

NPI Number	:	1184018160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE BRITTON PTA

Provider Business Mailing Address
First Line	:	14 WINSLOW LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-3713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WINSLOW LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-3713
Country	:	US
Telephone Number	:	636-346-7014
Fax Number	:

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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