Provider Demographics
NPI:1255948188
Name:BOSS, CAMILLE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:ELIZABETH
Last Name:BOSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CAMILLE
Other - Middle Name:ELIZABETH
Other - Last Name:LINDH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7421 MEXICO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1369
Mailing Address - Country:US
Mailing Address - Phone:636-757-6543
Mailing Address - Fax:
Practice Address - Street 1:7421 MEXICO RD STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1369
Practice Address - Country:US
Practice Address - Phone:636-757-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106548OtherPHYSICAL THERAPY