MEDICARE: JEAN STILES 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	2251X0800X	Orthopedic Physical Therapist	117926	MO

General Provider Information

NPI Number	:	1417518655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN STILES MPT

Provider Business Mailing Address
First Line	:	15945 CLAYTON RD STE 210
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2491
Country	:	US
Telephone Number	:	314-325-3068
Fax Number	:	314-325-3069

Provider Business Practice Location Address
First Line	:	15945 CLAYTON RD STE 210
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2491
Country	:	US
Telephone Number	:	314-325-3068
Fax Number	:	314-325-3069

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	06/27/2019

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Directions to “ JEAN STILES MPT” Practice Location

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