Healthcare Provider Details

I. General information

NPI: 1538198825
Provider Name (Legal Business Name): THE THERAPYSOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W HIGHWAY 28
OWENSVILLE MO
65066-1669
US

IV. Provider business mailing address

PO BOX 567
OWENSVILLE MO
65066-0567
US

V. Phone/Fax

Practice location:
  • Phone: 573-437-8011
  • Fax: 573-437-8022
Mailing address:
  • Phone: 573-437-8011
  • Fax: 573-437-8022

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: PAULA KAY COPELAND
Title or Position: PT/OWNER
Credential: PT
Phone: 573-437-8011