Provider Demographics
NPI:1063446987
Name:KAMMIEN, ELIZABETH ANN (PT/CHT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:KAMMIEN
Suffix:
Gender:F
Credentials:PT/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1253
Mailing Address - Country:US
Mailing Address - Phone:314-822-4400
Mailing Address - Fax:314-822-4111
Practice Address - Street 1:11135 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1253
Practice Address - Country:US
Practice Address - Phone:314-822-4400
Practice Address - Fax:314-822-4111
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO009782251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025130Medicare ID - Type Unspecified