Provider Demographics
NPI:1336306448
Name:PHYSICAL MEDICINE AND REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-373-8715
Mailing Address - Street 1:3445 S 291 HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2663
Mailing Address - Country:US
Mailing Address - Phone:816-373-8715
Mailing Address - Fax:816-795-9388
Practice Address - Street 1:3445 S 291 HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2663
Practice Address - Country:US
Practice Address - Phone:816-373-8715
Practice Address - Fax:816-795-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102396208100000X
KS05-27198208100000X
MO20080024072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty