Provider Demographics
NPI:1285862193
Name:PHYSICAL THERAPY OF WARRENSBURG
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF WARRENSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:660-747-0247
Mailing Address - Street 1:540 E YOUNG AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1231
Mailing Address - Country:US
Mailing Address - Phone:660-747-0247
Mailing Address - Fax:660-747-0347
Practice Address - Street 1:540 E YOUNG AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1231
Practice Address - Country:US
Practice Address - Phone:660-747-0247
Practice Address - Fax:660-747-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004834332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34248013OtherBCBS OF KC
MOR260000Medicare PIN