Provider Demographics
NPI:1548855513
Name:EDDY, JEFFREY JOHN (COF, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOHN
Last Name:EDDY
Suffix:
Gender:M
Credentials:COF, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 LANDS END CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5018
Mailing Address - Country:US
Mailing Address - Phone:636-236-2457
Mailing Address - Fax:
Practice Address - Street 1:12984 MAURER INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1564
Practice Address - Country:US
Practice Address - Phone:314-842-6750
Practice Address - Fax:314-842-6761
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer