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General NPI Number Information
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NPI Number | 1801247523
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Entity Type | Organization
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Legal Business Name | SHOW ME PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 1870 COMMERCIAL STREET
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City | WARSAW
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State | MO
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Zip | 65355
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Country | US
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Telephone | 660-723-4064
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Fax | 949-861-9331
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Provider Business Mailing Address
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Address Line | 17454 HENSLEY RD
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City | WARSAW
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State | MO
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Zip | 65355-5732
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Country | US
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Telephone | 660-723-4064
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Fax | 949-861-9331
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Authorized Official
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Title or Position | OWNER
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Name | RANDY SHANE JOHNSON
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Credential | P.T.
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Telephone | 660-723-4064
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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 | 2005010779
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License Number State | MO
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