Provider Demographics
NPI:1124286745
Name:PHYSICAL THERAPY CARE,MANUAL P.T. & INDUSTRIAL REHAB.CENTERP.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY CARE,MANUAL P.T. & INDUSTRIAL REHAB.CENTERP.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB.SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CATAPANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:417-865-0011
Mailing Address - Street 1:3003 E CHESTNUT EXPY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2527
Mailing Address - Country:US
Mailing Address - Phone:417-865-0011
Mailing Address - Fax:
Practice Address - Street 1:3003 E CHESTNUT EXPY
Practice Address - Street 2:SUITE 150
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2527
Practice Address - Country:US
Practice Address - Phone:417-865-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1385261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2350Medicare PIN