Individual
DR. JACOB KELLEY FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3074 WINGHAVEN BLVD, O FALLON, MO 63368-3620
(636) 265-4100
Mailing address
3513 BROOKSIDE CROSSING DR, SAINT CHARLES, MO 63301-4901
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2025017762
MO
Other
Enumeration date
05/28/2025
Last updated
05/28/2025
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