Healthcare Provider Details

I. General information

NPI: 1336139989
Provider Name (Legal Business Name): TYPALDOS PHYSICAL THERAPY AND REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 N STATE HIGHWAY CC
NIXA MO
65714-8015
US

IV. Provider business mailing address

1887 N STATE HIGHWAY CC
NIXA MO
65714-8015
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-5774
  • Fax: 417-725-5915
Mailing address:
  • Phone: 417-725-5774
  • Fax: 417-725-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN M TYPALDOS
Title or Position: PRESIDENT ADMINISTRATOR
Credential: PT
Phone: 417-725-5774