Healthcare Provider Details

I. General information

NPI: 1710324850
Provider Name (Legal Business Name): THERAPYPROS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 11/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E SPRINGFIELD ST
SAINT JAMES MO
65559-1646
US

IV. Provider business mailing address

PO BOX 778
SAINT JAMES MO
65559-0778
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-1105
  • Fax:
Mailing address:
  • Phone: 573-265-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number200174333
License Number StateMO

VIII. Authorized Official

Name: DIANA J BRANDT
Title or Position: OWNER/ADMINISTRATOR
Credential: PT
Phone: 573-265-1105