Healthcare Provider Details

I. General information

NPI: 1457396756
Provider Name (Legal Business Name): PHYSICAL THERAPY OF HIGGINSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 FAIRGROUND AVE
HIGGINSVILLE MO
64037-1638
US

IV. Provider business mailing address

720 FAIRGROUND AVE
HIGGINSVILLE MO
64037-1638
US

V. Phone/Fax

Practice location:
  • Phone: 660-584-7801
  • Fax: 660-584-8619
Mailing address:
  • Phone: 660-584-7801
  • Fax: 660-584-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID F BRUMMEL
Title or Position: OWNER/THERAPIST
Credential: MED RPT
Phone: 660-584-7801