Healthcare Provider Details

I. General information

NPI: 1659312619
Provider Name (Legal Business Name): PHYSICAL THERAPY SPECIALIST CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 W 8TH ST
WEST PLAINS MO
65775-2010
US

IV. Provider business mailing address

1480 W 8TH ST
WEST PLAINS MO
65775-2010
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-5669
  • Fax: 417-256-5699
Mailing address:
  • Phone: 417-256-5669
  • Fax: 417-256-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005362
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number01442
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number107429
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2006029256
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number116745
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2001031039
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number107041
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number118541
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number109647
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number114070
License Number StateMO
# 11
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2003019075
License Number StateMO
# 12
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2001033005
License Number StateMO
# 13
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2006020966
License Number StateMO
# 14
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number115072
License Number StateMO
# 15
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2003016144
License Number StateMO

VIII. Authorized Official

Name: MARY HELEN SHEID
Title or Position: CEO
Credential: PT, OCS
Phone: 417-256-5669