Provider Demographics
NPI:1255676516
Name:HUELSKOETTER, JANE DIANNE
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:DIANNE
Last Name:HUELSKOETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 POLO DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8358
Mailing Address - Country:US
Mailing Address - Phone:636-891-0075
Mailing Address - Fax:
Practice Address - Street 1:13550 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-5812
Practice Address - Country:US
Practice Address - Phone:314-878-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006452251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics