MEDICARE: JESSICA WEILER

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1366307175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WEILER

Provider Business Mailing Address
First Line	:	12411 ROTH RD
Second Line	:
City	:	FRENCH VILLAGE
State	:	MO
Zip	:	63036-1619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S BALLAS RD
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63141
Country	:	US
Telephone Number	:	314-467-7206
Fax Number	:

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ JESSICA WEILER ” Practice Location

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