Provider Demographics
NPI:1417518655
Name:STILES, JEAN (MPT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:FORSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15945 CLAYTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2491
Mailing Address - Country:US
Mailing Address - Phone:314-325-3068
Mailing Address - Fax:314-325-3069
Practice Address - Street 1:15945 CLAYTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2491
Practice Address - Country:US
Practice Address - Phone:314-325-3068
Practice Address - Fax:314-325-3069
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1179262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic