Healthcare Provider Details

I. General information

NPI: 1427983477
Provider Name (Legal Business Name): KATHERINE E IMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12563 VILLAGE CIRCLE DR
SAINT LOUIS MO
63127-1701
US

IV. Provider business mailing address

12563 VILLAGE CIRCLE DR
SAINT LOUIS MO
63127-1701
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2013025677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: