Provider Demographics
NPI:1780454207
Name:EILERS, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EILERS
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 1:5335 STATE ROUTE 161
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62245-2213
Mailing Address - Country:US
Mailing Address - Phone:618-409-6856
Mailing Address - Fax:
Practice Address - Street 1:1138 SHACKELFORD RD SPC 3
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4369
Practice Address - Country:US
Practice Address - Phone:314-907-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024005556225100000X
MO2023049891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist