Provider Demographics
NPI:1316393481
Name:YAMNITZ, KELLY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:YAMNITZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 INDEPENDENCE ST # B
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5826
Mailing Address - Country:US
Mailing Address - Phone:573-986-4411
Mailing Address - Fax:
Practice Address - Street 1:2126 INDEPENDENCE ST # B
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5826
Practice Address - Country:US
Practice Address - Phone:573-986-4411
Practice Address - Fax:573-986-4445
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist