Provider Demographics
NPI:1003960527
Name:FREELING, JENNIFER JO (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:FREELING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:KROPATSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3404 E TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4554
Mailing Address - Country:US
Mailing Address - Phone:636-970-0336
Mailing Address - Fax:636-970-0337
Practice Address - Street 1:3404 E TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4554
Practice Address - Country:US
Practice Address - Phone:636-970-0336
Practice Address - Fax:636-970-0337
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20000170888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025467Medicare ID - Type Unspecified