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General NPI Number Information
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NPI Number | 1851920474
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Entity Type | Individual
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Provider Name | ROBERT WILSON FLEMING PT
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 3535 S NATIONAL AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65807-7310
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Country | US
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Telephone | 417-269-5295
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Fax |
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Provider Business Mailing Address
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Address Line | 4336 E SERENADE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65809-2978
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Country | US
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Telephone | 417-882-7614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 01339
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License Number State | MO
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