Provider Demographics
NPI:1861605735
Name:SPRINGFIELD PHYSICAL THERAPY & REHABILITATION CENTER INC
Entity type:Organization
Organization Name:SPRINGFIELD PHYSICAL THERAPY & REHABILITATION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TOLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:417-887-0222
Mailing Address - Street 1:3259 E. SUNSHINE
Mailing Address - Street 2:SUITE AA
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-887-0222
Mailing Address - Fax:417-887-1916
Practice Address - Street 1:3259 E. SUNSHINE
Practice Address - Street 2:SUITE AA
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-887-0222
Practice Address - Fax:417-887-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBUS98-04435261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO575901706Medicaid
MO266555Medicare Oscar/Certification