Provider Demographics
NPI:1386187847
Name:ST. GEMME, CELESTE (DPT)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:ST. GEMME
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3131
Mailing Address - Country:US
Mailing Address - Phone:314-845-0068
Mailing Address - Fax:314-845-0025
Practice Address - Street 1:1355 W ROGERS BLVD STE 10
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-4205
Practice Address - Country:US
Practice Address - Phone:918-396-7125
Practice Address - Fax:918-396-7186
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016034461225100000X
OK5930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist