Provider Demographics
NPI:1003903436
Name:HEREFORD, JULIET (PT)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:HEREFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 PEBBLE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1412
Mailing Address - Country:US
Mailing Address - Phone:314-845-8622
Mailing Address - Fax:
Practice Address - Street 1:7508 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2104
Practice Address - Country:US
Practice Address - Phone:314-647-4880
Practice Address - Fax:314-647-1964
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist