Provider Demographics
NPI:1376262964
Name:PLETKA, EMILY JANE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:PLETKA
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 1:10332 OLD OLIVE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5922
Mailing Address - Country:US
Mailing Address - Phone:314-567-4707
Mailing Address - Fax:314-567-4505
Practice Address - Street 1:10332 OLD OLIVE STREET RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5922
Practice Address - Country:US
Practice Address - Phone:314-567-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022033777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist