Individual
MRS. JESSE MARIE CIVELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
222 S MERAMEC AVENUE, SUITE 100, CLAYTON, MO 63105
(314) 707-4179
(314) 286-1473
Mailing address
222 S MERAMEC AVENUE, SUITE 100, CLAYTON, MO 63105
(314) 707-4179
(314) 286-1473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2013043933
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
480057326
—
MO
Enumeration date
01/20/2014
Last updated
12/11/2019
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