Basic Information
| Provider Information | |||||||||
| NPI: | 1013142892 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIDWEST THERAPY SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OZARK PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 N WESTWOOD BLVD | ||||||||
| Address2: | SUITE 17 | ||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736864209 | ||||||||
| FaxNumber: | 5736864406 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 N WESTWOOD BLVD STE 17 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737789348 | ||||||||
| FaxNumber: | 5736864870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TINSLEY | ||||||||
| AuthorizedOfficialFirstName: | AUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5736864209 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | IV | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.