Provider Demographics
NPI:1356545214
Name:JOKERST, MARY BETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:JOKERST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8286 RIVER HILLS LN
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-8509
Mailing Address - Country:US
Mailing Address - Phone:573-883-7368
Mailing Address - Fax:
Practice Address - Street 1:21964 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:SAINTE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-9190
Practice Address - Country:US
Practice Address - Phone:573-883-9366
Practice Address - Fax:573-883-9377
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO115703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant