Provider Demographics
NPI:1528010626
Name:ONSITE REHABILITATION, PC
Entity Type:Organization
Organization Name:ONSITE REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER, SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-302-4446
Mailing Address - Street 1:1037 PALISADES BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3527
Mailing Address - Country:US
Mailing Address - Phone:573-302-4446
Mailing Address - Fax:573-302-4447
Practice Address - Street 1:1037 PALISADES BLVD STE 6
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3527
Practice Address - Country:US
Practice Address - Phone:573-302-4446
Practice Address - Fax:573-302-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO488398405Medicaid
MO000014923Medicare PIN