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General NPI Number Information
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NPI Number | 1558436592
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Entity Type | Organization
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Legal Business Name | CENTRAL MISSOURI PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 303 N KEENE ST
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City | COLUMBIA
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State | MO
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Zip | 65201-7193
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Country | US
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Telephone | 573-443-0225
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Fax | 660-443-0290
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Provider Business Mailing Address
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Address Line | 303 N KEENE ST
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City | COLUMBIA
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State | MO
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Zip | 65201-7193
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Country | US
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Telephone | 573-443-0225
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Fax | 660-443-0290
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Authorized Official
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Title or Position | PT
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Name | PHILLIP SMITH
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Credential | PT
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Telephone | 573-443-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2001024950
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License Number State | MO
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