Healthcare Provider Details

I. General information

NPI: 1750446688
Provider Name (Legal Business Name): AMERICAN PHYSICAL THERAPY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 HIGHWAY 54 SUITE 102
OSAGE BEACH MO
65065-3046
US

IV. Provider business mailing address

PO BOX 1776
OSAGE BEACH MO
65065-1776
US

V. Phone/Fax

Practice location:
  • Phone: 573-348-4004
  • Fax: 573-348-3272
Mailing address:
  • Phone: 573-348-4004
  • Fax: 573-348-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01853
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier504447400
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: DAWN M STANDLEY
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: D.P.T.
Phone: 573-348-4004