Provider Demographics
NPI:1215982095
Name:CENTRAL MISSOURI PHYSICAL THERAPY
Entity type:Organization
Organization Name:CENTRAL MISSOURI PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:660-263-6223
Mailing Address - Street 1:300 N MORLEY ST STE I
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2334
Mailing Address - Country:US
Mailing Address - Phone:660-263-6223
Mailing Address - Fax:
Practice Address - Street 1:300 N MORLEY ST STE I
Practice Address - Street 2:SUITE I
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2334
Practice Address - Country:US
Practice Address - Phone:660-263-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024950261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO217494243Medicare PIN