Jesse Marie Civello, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2013043933 Issued in MO

Practice address

222 S Meramec Avenue
Suite 100
Clayton, MO 63105

Phone

(314) 707-4179

Fax

(314) 286-1473

NPI assigned

Jan 20, 2014

Last updated

Dec 11, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1390176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1861814261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S MERAMEC AVENUE",
            "address_2": "SUITE 100",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "63105",
            "telephone_number": "314-707-4179",
            "fax_number": "314-286-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S MERAMEC AVENUE",
            "address_2": "SUITE 100",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "63105",
            "telephone_number": "314-707-4179",
            "fax_number": "314-286-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVELLO",
        "first_name": "JESSE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-20",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2013043933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "480057326",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kailye Kelly Chu, PHARM.D.
• Brianna Lee Chung, FNP
• Joy Ciskowski, MA, LPC
• City of Clayton Attn Finance Department (City of Clayton Fire Department)
• City Speech Inc
• Clayton Adam Clark, MED
• Emily Cler, OTR/L
• Jerry C Clerc, MED LPC
• Mallory A Cline
• Linda R. Cohn, M.S.W., L.C.S.W.

• Physical Therapist in Clayton, MO
• Providers in Clayton, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.