MEDICARE: MRS. ANN JAROSIK BLAES

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	02238	MO

General Provider Information

NPI Number	:	1780889949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN JAROSIK BLAES

Provider Business Mailing Address
First Line	:	125 FENTON PARK CT
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-7611
Country	:	US
Telephone Number	:	636-717-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WOODLAND MNR
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2030
Country	:	US
Telephone Number	:	636-296-1400
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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