Provider Demographics
NPI:1376562413
Name:OZARK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OZARK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ATHLETIC TRAINER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC/R
Authorized Official - Phone:573-778-9348
Mailing Address - Street 1:784 HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-6657
Mailing Address - Country:US
Mailing Address - Phone:573-778-9348
Mailing Address - Fax:573-686-4870
Practice Address - Street 1:2725 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2346
Practice Address - Country:US
Practice Address - Phone:573-778-9348
Practice Address - Fax:573-686-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty