Provider Demographics
NPI:1912954363
Name:PEIFER, CARRIE MICHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:MICHELLE
Last Name:PEIFER
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 1:300 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-1647
Mailing Address - Country:US
Mailing Address - Phone:417-967-0900
Mailing Address - Fax:
Practice Address - Street 1:300 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-1647
Practice Address - Country:US
Practice Address - Phone:417-967-0900
Practice Address - Fax:417-967-0905
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003021175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO489102426Medicaid
MO218244929Medicare PIN