Basic Information
| Provider Information | |||||||||
| NPI: | 1801905419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEEPE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | BRYAN | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11939 KENDON DR | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631314117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147184560 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 VIERSE DR | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737562937 | ||||||||
| FaxNumber: | 5737562939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 06/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 112727 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.