Healthcare Provider Details

I. General information

NPI: 1649970179
Provider Name (Legal Business Name): KIMBERLY ALICE LAMZIK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7068 S OUTER 364
O FALLON MO
63368-7757
US

IV. Provider business mailing address

65 N JOYCE ELLEN WAY
SAINT PETERS MO
63376-1203
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-6100
  • Fax:
Mailing address:
  • Phone: 636-699-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number102125
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: