Provider Demographics
NPI:1285762914
Name:JOHN M. TYPALDOS, P.T.
Entity type:Organization
Organization Name:JOHN M. TYPALDOS, P.T.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TYPALDOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:417-725-5774
Mailing Address - Street 1:1887 N STATE HIGHWAY CC
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8015
Mailing Address - Country:US
Mailing Address - Phone:417-725-5774
Mailing Address - Fax:417-725-5915
Practice Address - Street 1:1887 N STATE HIGHWAY CC
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8015
Practice Address - Country:US
Practice Address - Phone:417-725-5774
Practice Address - Fax:417-725-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001773Medicare ID - Type Unspecified