Provider Demographics
NPI:1164104568
Name:SAINT LOUIS, JEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SAINT LOUIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SE VOLTAIR TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3700
Mailing Address - Country:US
Mailing Address - Phone:772-267-4855
Mailing Address - Fax:
Practice Address - Street 1:10743 NARCOOSSEE RD STE A24
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6947
Practice Address - Country:US
Practice Address - Phone:407-845-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist