Healthcare Provider Details

I. General information

NPI: 1255236345
Provider Name (Legal Business Name): PHILLIP JOHN EMLING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 N MAIN ST
MOUNTAIN GROVE MO
65711-1025
US

IV. Provider business mailing address

8929 HIGHWAY N
MOUNTAIN GROVE MO
65711-2075
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-5699
  • Fax: 417-926-5703
Mailing address:
  • Phone: 330-858-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2018019969
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: