Provider Demographics
NPI:1437178167
Name:FUCHS, JESSICA FRISHBERG
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRISHBERG
Last Name:FUCHS
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 1:4800 MEXICO RD 104
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:636-939-9540
Mailing Address - Fax:636-939-9886
Practice Address - Street 1:5513 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4106
Practice Address - Country:US
Practice Address - Phone:770-551-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00263716OtherMEDICARE RAILROAD NUMBER
SC943423122OtherINSURANCE PROVIDER NUMBER
SCQ339367278Medicare ID - Type UnspecifiedPROVIDER NUMBER