Basic Information
| Provider Information | |||||||||
| NPI: | 1417048794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YEMM | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 BERRYWOOD DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734496082 | ||||||||
| FaxNumber: | 5734490401 | ||||||||
| Practice Location | |||||||||
| Address1: | 8790 WATSON RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631195140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142708671 | ||||||||
| FaxNumber: | 3142708673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 2000154595 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.