Provider Demographics
NPI:1417048794
Name:YEMM, THEODORE P (PT, ATC)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:P
Last Name:YEMM
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-449-6082
Mailing Address - Fax:573-449-0401
Practice Address - Street 1:8790 WATSON RD
Practice Address - Street 2:STE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5140
Practice Address - Country:US
Practice Address - Phone:314-270-8671
Practice Address - Fax:314-270-8673
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20001545952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
218871806Medicare PIN