Healthcare Provider Details

I. General information

NPI: 1043697899
Provider Name (Legal Business Name): ELIZABETH THIEMAN PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH HEVERN

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NW VESPER ST
BLUE SPRINGS MO
64014-2745
US

IV. Provider business mailing address

1009 NE HUNTERS RD
BLUE SPRINGS MO
64014-6519
US

V. Phone/Fax

Practice location:
  • Phone: 914-715-0128
  • Fax:
Mailing address:
  • Phone: 914-715-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026001564
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2014023823
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: