Healthcare Provider Details

I. General information

NPI: 1053225086
Provider Name (Legal Business Name): LINDA CREMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E DUNKLIN ST
JEFFERSON CITY MO
65101-3128
US

IV. Provider business mailing address

315 E DUNKLIN ST
JEFFERSON CITY MO
65101-3128
US

V. Phone/Fax

Practice location:
  • Phone: 573-659-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number117928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: