MEDICARE: ERIN CHISHOLM PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2009035294	MO

General Provider Information

NPI Number	:	1528370566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN CHISHOLM PT

Provider Business Mailing Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 300
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-647-0495
Fax Number	:	314-647-1350

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 300
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-647-0495
Fax Number	:	314-647-1350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	06/13/2012

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