Provider Demographics
NPI:1174614648
Name:PRATT, JANET (PT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:PRATT
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 1:12539 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6311
Mailing Address - Country:US
Mailing Address - Phone:314-205-2006
Mailing Address - Fax:314-205-2241
Practice Address - Street 1:12539 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6311
Practice Address - Country:US
Practice Address - Phone:314-205-2006
Practice Address - Fax:314-205-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01821261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025466Medicare ID - Type Unspecified