Provider Demographics
NPI:1134317951
Name:CRITCHFIELD PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:CRITCHFIELD PHYSICAL THERAPY PC
Other - Org Name:MONTGOMERY COUNTY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CRITCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:573-564-5222
Mailing Address - Street 1:520 N STURGEON ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1829
Mailing Address - Country:US
Mailing Address - Phone:573-564-5222
Mailing Address - Fax:
Practice Address - Street 1:520 N STURGEON ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1829
Practice Address - Country:US
Practice Address - Phone:573-564-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104230261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001700Medicare PIN