Provider Demographics
NPI:1780620724
Name:PHYSICAL THERAPY OF CONCORDIA INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF CONCORDIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:660-463-2588
Mailing Address - Street 1:607 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020
Mailing Address - Country:US
Mailing Address - Phone:660-463-2588
Mailing Address - Fax:660-463-2589
Practice Address - Street 1:607 SOUTH MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020
Practice Address - Country:US
Practice Address - Phone:660-463-2588
Practice Address - Fax:660-463-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34249011OtherBCBSKC
MOR220000Medicare PIN