Provider Demographics
NPI:1780889949
Name:BLAES, ANN JAROSIK
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:JAROSIK
Last Name:BLAES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:JAROSIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:125 FENTON PARK CT
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7611
Mailing Address - Country:US
Mailing Address - Phone:636-717-0105
Mailing Address - Fax:
Practice Address - Street 1:100 WOODLAND MNR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2030
Practice Address - Country:US
Practice Address - Phone:636-296-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist