Provider Demographics
NPI:1558979583
Name:JUSTUPRIGHT THERAPY SERVICES
Entity Type:Organization
Organization Name:JUSTUPRIGHT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINALYN
Authorized Official - Middle Name:LACSON
Authorized Official - Last Name:RUDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:314-287-0757
Mailing Address - Street 1:4977 SEIBERT AVE
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4736
Mailing Address - Country:US
Mailing Address - Phone:314-287-0757
Mailing Address - Fax:
Practice Address - Street 1:4977 SEIBERT AVE
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-4736
Practice Address - Country:US
Practice Address - Phone:314-287-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012009718OtherMISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS