Healthcare Provider Details

I. General information

NPI: 1326221078
Provider Name (Legal Business Name): FRANK EITEMILLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17196 CONDOR DR.
SENECA MO
64865
US

IV. Provider business mailing address

17196 CONDOR DR.
SENECA MO
64865
US

V. Phone/Fax

Practice location:
  • Phone: 417-776-3275
  • Fax:
Mailing address:
  • Phone: 417-776-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01312
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: