Provider Demographics
NPI:1003125659
Name:KURTZ, ANNIKA EVA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNIKA
Middle Name:EVA
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2758 HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-6936
Mailing Address - Country:US
Mailing Address - Phone:314-489-0787
Mailing Address - Fax:
Practice Address - Street 1:3789 NEW TOWN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4358
Practice Address - Country:US
Practice Address - Phone:636-669-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001002216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist