Basic Information
| Provider Information | |||||||||
| NPI: | 1376562413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OZARK PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 HIGHWAY M | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639016657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737789348 | ||||||||
| FaxNumber: | 5736864870 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 N WESTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737789348 | ||||||||
| FaxNumber: | 5736864870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BASS | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CERTIFIED ATHLETIC TRAINER | ||||||||
| AuthorizedOfficialTelephone: | 5737789348 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | ATC/R | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 117264 | MO | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.