Provider Demographics
NPI:1609218742
Name:EMMART, CALLIE COPPEDGE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:COPPEDGE
Last Name:EMMART
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 147G
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-8107
Mailing Address - Country:US
Mailing Address - Phone:417-683-0187
Mailing Address - Fax:
Practice Address - Street 1:403 HWY 160 WEST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65655
Practice Address - Country:US
Practice Address - Phone:417-679-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005438225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics