Healthcare Provider Details

I. General information

NPI: 1104906338
Provider Name (Legal Business Name): OZARKS PHYSICAL THERAPY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S NATIONAL AVE SUITE 302
SPRINGFIELD MO
65804-2213
US

IV. Provider business mailing address

1911 S NATIONAL AVE SUITE 302
SPRINGFIELD MO
65804-2213
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-4164
  • Fax: 417-881-1727
Mailing address:
  • Phone: 417-881-4164
  • Fax: 417-881-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRO114
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL B BOYD
Title or Position: PRESIDENT
Credential:
Phone: 417-881-4164