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General NPI Number Information
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NPI Number | 1891985776
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Entity Type | Organization
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Legal Business Name | ADVANCE PHYCIAL THERAPY & SPORTS MED
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 1108 E PATTERSON ST SUITE 6
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4002
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Country | US
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Telephone | 660-665-5333
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Fax | 660-665-5332
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Provider Business Mailing Address
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Address Line | 1108 E PATTERSON ST SUITE 6
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4002
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Country | US
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Telephone | 660-665-5333
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Fax | 660-665-5332
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Authorized Official
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Title or Position | P.T./OWNER
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Name | MS. AMY MARIE FLESHMAN
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Credential | P.T
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Telephone | 660-665-5333
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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 | 02255
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License Number State | MO
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