MEDICARE: CENTRAL MISSOURI PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	2001024950	MO

General Provider Information

NPI Number	:	1215982095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MISSOURI PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	300 N MORLEY ST STE I
Second Line	:	PO BOX 429
City	:	MOBERLY
State	:	MO
Zip	:	65270-2334
Country	:	US
Telephone Number	:	660-263-6223
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N MORLEY ST STE I
Second Line	:	SUITE I
City	:	MOBERLY
State	:	MO
Zip	:	65270-2334
Country	:	US
Telephone Number	:	660-263-6223
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST OWNER
Name	:	MR. PHILLIP JOSEPH SMITH
Credential	:	MPT
Telephone Number	:	660-263-6223

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/04/2008

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