Provider Demographics
NPI:1740541846
Name:SKEMP, MARCI JEAN (DPT)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:JEAN
Last Name:SKEMP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:JEAN
Other - Last Name:BURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2814 S BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4640
Mailing Address - Country:US
Mailing Address - Phone:660-785-1834
Mailing Address - Fax:660-785-1825
Practice Address - Street 1:2814 S BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4640
Practice Address - Country:US
Practice Address - Phone:660-785-1834
Practice Address - Fax:660-785-1825
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1811026Medicare PIN