Provider Demographics
NPI:1023245206
Name:NIEMEIER, CAITLIN M (MPT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:NIEMEIER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:M
Other - Last Name:WEINDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2454 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2548
Mailing Address - Country:US
Mailing Address - Phone:636-916-4625
Mailing Address - Fax:636-916-4628
Practice Address - Street 1:1096 TOM GINNEVER AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4519
Practice Address - Country:US
Practice Address - Phone:636-978-5255
Practice Address - Fax:636-978-5287
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00790471OtherRAILROAD MEDICARE
MO164300004Medicare PIN