Provider Demographics
NPI:1588714513
Name:KAMSTRA, EILEEN JOY (PT)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:JOY
Last Name:KAMSTRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:219-661-8275
Mailing Address - Fax:219-661-8998
Practice Address - Street 1:1129 MERRILLVILLE RD
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-661-8008
Practice Address - Fax:219-661-8998
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004069A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35-2091369Medicare UPIN
IN259330BMedicare PIN
IN199230BMedicare ID - Type Unspecified