MEDICARE: MRS. ANNE M JOERGENS PT

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	01905	MO
2	225100000X	Physical Therapist	070.009192	IL

General Provider Information

NPI Number	:	1205101409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE M JOERGENS PT

Provider Business Mailing Address
First Line	:	11969 WESTLINE INDUSTRIAL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3203
Country	:	US
Telephone Number	:	314-819-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	11969 WESTLINE INDUSTRIAL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3203
Country	:	US
Telephone Number	:	314-819-0480
Fax Number	:

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

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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