Provider Demographics
NPI:1396059176
Name:WELKENER, JACQUELINE LEE (PT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEE
Last Name:WELKENER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 LEGACY CIR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2375
Mailing Address - Country:US
Mailing Address - Phone:636-326-5655
Mailing Address - Fax:
Practice Address - Street 1:201 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4305
Practice Address - Country:US
Practice Address - Phone:314-984-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO020312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic