Healthcare Provider Details

I. General information

NPI: 1558436592
Provider Name (Legal Business Name): CENTRAL MISSOURI PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N KEENE ST
COLUMBIA MO
65201-7193
US

IV. Provider business mailing address

303 N KEENE ST
COLUMBIA MO
65201-7193
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-0225
  • Fax: 660-443-0290
Mailing address:
  • Phone: 573-443-0225
  • Fax: 660-443-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2001024950
License Number StateMO

VIII. Authorized Official

Name: PHILLIP SMITH
Title or Position: PT
Credential: PT
Phone: 573-443-0225