Provider Demographics
NPI:1427316801
Name:AFFINITY ORTHOPEDIC & SPORTS THERAPY, LLC
Entity type:Organization
Organization Name:AFFINITY ORTHOPEDIC & SPORTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:573-774-3666
Mailing Address - Street 1:24530 SOUTHSIDE RD
Mailing Address - Street 2:SUITE # E/F
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-3317
Mailing Address - Country:US
Mailing Address - Phone:573-774-3666
Mailing Address - Fax:
Practice Address - Street 1:24530 SOUTHSIDE RD
Practice Address - Street 2:SUITE# E/F
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-3317
Practice Address - Country:US
Practice Address - Phone:573-774-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118519261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy