Basic Information
| Provider Information | |||||||||
| NPI: | 1902299399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANTAGE HAND THERAPY & ORTHOPEDIC REHABILITATION | ||||||||
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| OtherOrganizationName: | ADVANTAGE THERAPY-MONETT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 864 E HWY 60 STE A | ||||||||
| Address2: | |||||||||
| City: | MONETT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657088291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176351185 | ||||||||
| FaxNumber: | 4176351187 | ||||||||
| Practice Location | |||||||||
| Address1: | 864 E HWY 60 STE A | ||||||||
| Address2: | |||||||||
| City: | MONETT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657088291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176351185 | ||||||||
| FaxNumber: | 4176351187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2015 | ||||||||
| LastUpdateDate: | 03/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCROGGINS | ||||||||
| AuthorizedOfficialFirstName: | JEANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4178894800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2014023789 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.