MEDICARE: JUNCTION BRACING & PT LLC

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

General Provider Information

NPI Number	:	1437800026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNCTION BRACING & PT LLC

Provider Business Mailing Address
First Line	:	4537 BRIGHTON CT
Second Line	:
City	:	HIGH RIDGE
State	:	MO
Zip	:	63049-3239
Country	:	US
Telephone Number	:	636-677-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 OLD BALLAS RD STE 128
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7070
Country	:	US
Telephone Number	:	314-801-8776
Fax Number	:	314-801-8775

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE WATKINS
Credential	:	PT
Telephone Number	:	314-265-0033

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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