Basic Information
| Provider Information | |||||||||
| NPI: | 1942272836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OZARK PHYSICAL THERAPY, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 N WESTWOOD BLVD | ||||||||
| Address2: | SUITE 17 | ||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865510 | ||||||||
| FaxNumber: | 5736866846 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 N WESTWOOD BLVD | ||||||||
| Address2: | SUITE 17 | ||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865510 | ||||||||
| FaxNumber: | 5736866846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | TINSLEY | ||||||||
| AuthorizedOfficialFirstName: | AUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5736864209 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | IV | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 146356 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 4630980001 | 01 | MO | DME NUMBER | OTHER |