Provider Demographics
NPI:1962664052
Name:ALTEMEYER, ANITA FARRIS (PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:FARRIS
Last Name:ALTEMEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ELDON ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 HARTMAN PLACE
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077
Practice Address - Country:US
Practice Address - Phone:636-629-9826
Practice Address - Fax:636-467-7094
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007034421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist