Kamil Dostalik, PT
Individual provider Active NPI Physical Therapist · Saint Clair, MO
NPI 1487869368 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487869368
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 02070 (MO)
- Practice address
- 1135 N Commercial Ave
Saint Clair, MO 63077-1012 - Phone
- (636) 629-8110
- Fax
- (636) 583-8960
- NPI assigned
- May 13, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02070 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 02070 | MO | Yes |
Addresses
Primary practice location
1135 N Commercial Ave
Saint Clair, MO 63077-1012
Mailing address
20 Stablestone Dr
Union, MO 63084-4417
Phone (636) 629-8110
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 483847208 | Medicaid | MO |
Other providers in Saint Clair, MO
- Kayala Sue Cooper
- Charles Michael Curtis
- Yunus Emre Demirhan
- Dennis J. McCoy, D.D.S., P.C.
- Divine Spine Chiropractic, LLC
- Jessie A Elder
- Elite Access & Renovations, LLC
- Ashley Erickson
- Family Planning Clinic of Franklin Co
- Michael Shaun Fisher
All providers in Saint Clair, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.