Healthcare Provider Details

I. General information

NPI: 1043608144
Provider Name (Legal Business Name): ELKA FOLLMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 US HWY 61
FESTUS MO
63028
US

IV. Provider business mailing address

1106 WALNUT ST
SAINT LOUIS MO
63102-1154
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-2291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2001026575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: