Jacob Kelley Frederick, DPT Valid NPI
Individual provider · Physical Therapist · O Fallon, MO
- NPI
- 1124811393
- Type
- Individual (Type 1)
- Primary specialty
- Physical Therapist
- Specialty group
- Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Taxonomy code
- 225100000X
- License number
- 2025017762 (MO)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2025-05-28
- Last updated
- 2025-05-28
Practice location
3074 Winghaven Blvd
O Fallon, MO 63368-3620
(636) 265-4100