Provider Demographics
NPI:1619077732
Name:PHYSICAL THERAPY & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MELLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-2878
Mailing Address - Street 1:1343 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-2878
Mailing Address - Fax:816-232-5056
Practice Address - Street 1:1343 VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-2878
Practice Address - Fax:816-232-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
06213018OtherBLUE CROSS BLUE SHIELD
266508Medicare ID - Type Unspecified