Provider Demographics
NPI:1154667020
Name:DRUMMER, EMILY MICHELE (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELE
Last Name:DRUMMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 CAULKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-2617
Mailing Address - Country:US
Mailing Address - Phone:314-922-9463
Mailing Address - Fax:
Practice Address - Street 1:7068 S OUTER ROAD 364
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7757
Practice Address - Country:US
Practice Address - Phone:636-240-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029434225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant