MEDICARE: ORVAL JEFFREY MATHER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	01360	MO

General Provider Information

NPI Number	:	1215701974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORVAL JEFFREY MATHER PT

Provider Business Mailing Address
First Line	:	3007 N BELT HWY STE L
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1557
Country	:	US
Telephone Number	:	660-853-1302
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 N BELT HWY STE L
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1557
Country	:	US
Telephone Number	:	660-853-1302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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