Provider Demographics
NPI:1174718753
Name:VESPER, JODY LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:VESPER
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 1:7733 FORSYTH BLVD STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1806
Mailing Address - Country:US
Mailing Address - Phone:180-667-1238
Mailing Address - Fax:
Practice Address - Street 1:204 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-1614
Practice Address - Country:US
Practice Address - Phone:620-278-3651
Practice Address - Fax:620-278-2564
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist