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General NPI Number Information
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NPI Number | 1427316801
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Entity Type | Organization
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Legal Business Name | AFFINITY ORTHOPEDIC & SPORTS THERAPY, LLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 24530 SOUTHSIDE RD SUITE# E/F
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City | WAYNESVILLE
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State | MO
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Zip | 65583-3317
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Country | US
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Telephone | 573-774-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 24530 SOUTHSIDE RD SUITE # E/F
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City | WAYNESVILLE
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State | MO
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Zip | 65583-3317
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Country | US
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Telephone | 573-774-3666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL CAWLEY
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Credential | P.T.
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Telephone | 573-774-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 118519
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License Number State | MO
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