Healthcare Provider Details

I. General information

NPI: 1639018419
Provider Name (Legal Business Name): MICHAEL T JOSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 N KANSAS EXPY STE 104
SPRINGFIELD MO
65803-1169
US

IV. Provider business mailing address

2725 N KANSAS EXPY STE 104
SPRINGFIELD MO
65803-1169
US

V. Phone/Fax

Practice location:
  • Phone: 417-689-8797
  • Fax:
Mailing address:
  • Phone: 417-689-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2024010645
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: