Provider Demographics
NPI:1215701974
Name:MATHER, ORVAL JEFFREY (PT)
Entity type:Individual
Prefix:
First Name:ORVAL
Middle Name:JEFFREY
Last Name:MATHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 N BELT HWY STE L
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1557
Mailing Address - Country:US
Mailing Address - Phone:660-853-1302
Mailing Address - Fax:
Practice Address - Street 1:3007 N BELT HWY STE L
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1557
Practice Address - Country:US
Practice Address - Phone:660-853-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist