MEDICARE: MRS. JEAN Z DRAZEN P.T.

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	00777	MO

General Provider Information

NPI Number	:	1932387909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN Z DRAZEN P.T.

Provider Business Mailing Address
First Line	:	1658 LEGEND LANE CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4872
Country	:	US
Telephone Number	:	314-997-6832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 PARKWOOD LN
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1334
Country	:	US
Telephone Number	:	314-344-8978
Fax Number	:

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

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

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