Provider Demographics
NPI:1144995556
Name:WILLIMANN, EMMALEE (PTA)
Entity type:Individual
Prefix:
First Name:EMMALEE
Middle Name:
Last Name:WILLIMANN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 NEW TRUXTON RD
Mailing Address - Street 2:
Mailing Address - City:TRUXTON
Mailing Address - State:MO
Mailing Address - Zip Code:63381-2402
Mailing Address - Country:US
Mailing Address - Phone:636-221-2934
Mailing Address - Fax:
Practice Address - Street 1:1481 MARBACH DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4636
Practice Address - Country:US
Practice Address - Phone:636-239-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025151225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant