Provider Demographics
NPI:1740473537
Name:MEEKS, JASON LAMAR (LMT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:LAMAR
Last Name:MEEKS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 MONOPOLY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1520
Mailing Address - Country:US
Mailing Address - Phone:314-532-1695
Mailing Address - Fax:
Practice Address - Street 1:1435 MONOPOLY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1520
Practice Address - Country:US
Practice Address - Phone:314-532-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist