Provider Demographics
NPI:1902047640
Name:ADVANTAGE HAND THERAPY & ORTHOPEDIC REHABILITATION
Entity Type:Organization
Organization Name:ADVANTAGE HAND THERAPY & ORTHOPEDIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-889-4800
Mailing Address - Street 1:3045 S NATIONAL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4268
Mailing Address - Country:US
Mailing Address - Phone:417-889-4800
Mailing Address - Fax:417-889-0980
Practice Address - Street 1:3045 S NATIONAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4268
Practice Address - Country:US
Practice Address - Phone:417-889-4800
Practice Address - Fax:417-889-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115001261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy