Provider Demographics
NPI:1306171053
Name:MID AMERICA REHAB
Entity type:Organization
Organization Name:MID AMERICA REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:573-783-6688
Mailing Address - Street 1:206 HOSPITAL LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-768-3349
Mailing Address - Fax:
Practice Address - Street 1:206 HOSPITAL LN
Practice Address - Street 2:SUITE 100
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-768-3349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy