Healthcare Provider Details

I. General information

NPI: 1356315105
Provider Name (Legal Business Name): JAMES R STOVALL PT,ATC,CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST SUITE 1
MOUNTAIN GROVE MO
65711-1025
US

IV. Provider business mailing address

7519 HIGHWAY 17
HOUSTON MO
65483-2602
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-5699
  • Fax: 417-926-5703
Mailing address:
  • Phone: 417-967-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number114070
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2007016208
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: