Provider Demographics
NPI:1881892537
Name:FOLLMER, DAWN RENAE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENAE
Last Name:FOLLMER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:RENAE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:5280 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-4341
Mailing Address - Country:US
Mailing Address - Phone:314-712-4820
Mailing Address - Fax:
Practice Address - Street 1:5280 HOLLAND DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-4341
Practice Address - Country:US
Practice Address - Phone:314-712-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant