Provider Demographics
NPI:1295846244
Name:FLYNN, JULIE CRISTYN (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CRISTYN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:CRISTYN MURPHY
Other - Last Name:STEGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6424 POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139
Mailing Address - Country:US
Mailing Address - Phone:314-832-1791
Mailing Address - Fax:
Practice Address - Street 1:4600 CHIPPEWA
Practice Address - Street 2:STE F
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116
Practice Address - Country:US
Practice Address - Phone:314-351-7172
Practice Address - Fax:314-351-6885
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist