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General NPI Number Information
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NPI Number | 1659762474
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY AND REHAB LLC
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 1001 W SYCAMORE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2548
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Country | US
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Telephone | 417-848-6234
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Fax | 417-886-1983
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Provider Business Mailing Address
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Address Line | 1001 W SYCAMORE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2548
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Country | US
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Telephone | 417-848-6234
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Fax | 417-886-1983
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN HASHAGEN
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Credential | PT
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Telephone | 417-848-6234
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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 | 118161
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License Number State | MO
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