MEDICARE: EMPOWERME REHABILITATION MISSOURI LLC

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1801467923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERME REHABILITATION MISSOURI LLC

Provider Business Mailing Address
First Line	:	PO BOX 736005
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-6005
Country	:	US
Telephone Number	:	844-502-7996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1146 E LAKEWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2614
Country	:	US
Telephone Number	:	844-502-7996
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	JOHN DAVID CHURCH
Credential	:
Telephone Number	:	618-972-5228

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	09/23/2024

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