MEDICARE: MRS. JENNIFER FAYE NOELKER 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	104801	MO

General Provider Information

NPI Number	:	1811172414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER FAYE NOELKER PT

Provider Business Mailing Address
First Line	:	2460 STONECREST DR
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5566
Country	:	US
Telephone Number	:	636-221-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 STONECREST DR
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5566
Country	:	US
Telephone Number	:	636-221-5188
Fax Number	:

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/20/2022

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