Provider Demographics
NPI:1356315105
Name:STOVALL, JAMES R (PT,ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:STOVALL
Suffix:
Gender:M
Credentials:PT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7519 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2602
Mailing Address - Country:US
Mailing Address - Phone:417-967-3318
Mailing Address - Fax:
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1025
Practice Address - Country:US
Practice Address - Phone:417-926-5699
Practice Address - Fax:417-926-5703
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1140702255A2300X
MO2007016208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist