MEDICARE: THEODORE P YEMM PT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2000154595	MO

General Provider Information

NPI Number	:	1417048794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE P YEMM PT, ATC

Provider Business Mailing Address
First Line	:	3301 BERRYWOOD DR
Second Line	:	SUITE 204
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6517
Country	:	US
Telephone Number	:	573-449-6082
Fax Number	:	573-449-0401

Provider Business Practice Location Address
First Line	:	8790 WATSON RD
Second Line	:	STE 102
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5140
Country	:	US
Telephone Number	:	314-270-8671
Fax Number	:	314-270-8673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	11/17/2015

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