Active NPI
Eunice Delores Fredrickson, P.T.
- Physical Therapist
- Florissant, MO
National Provider Identifier
1992034896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2009035682
- Practice address
- 6768 N Highway 67
Florissant, MO 63034-2742 - Phone
- (314) 741-9101
- NPI assigned
- Dec 24, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2009035682 | MO | Primary |
| Physical Therapist | 225100000X | 070017473 | IL |
Addresses
Primary practice location
6768 N Highway 67
Florissant, MO 63034-2742
Mailing address
6768 North Hwy 67
Florissant, MO 63034
Phone (314) 741-9101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070017473 | IL | MD | Physical Therapist |
| 2009035682 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261612800000",
"number": "1992034896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6768 NORTH HWY 67",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "63034",
"telephone_number": "314-741-9101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6768 N HIGHWAY 67",
"city": "FLORISSANT",
"state": "MO",
"postal_code": "630342742",
"telephone_number": "314-741-9101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRICKSON",
"first_name": "EUNICE",
"middle_name": "DELORES",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-24",
"last_updated": "2009-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2009035682",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070017473",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florissant, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.