Provider Demographics
NPI:1538198825
Name:THE THERAPYSOURCE LLC
Entity type:Organization
Organization Name:THE THERAPYSOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:573-437-8011
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-0567
Mailing Address - Country:US
Mailing Address - Phone:573-437-8011
Mailing Address - Fax:573-437-8022
Practice Address - Street 1:1212 W HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1669
Practice Address - Country:US
Practice Address - Phone:573-437-8011
Practice Address - Fax:573-437-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO574687307Medicaid
MO266612Medicare Oscar/Certification