Provider Demographics
NPI:1619139227
Name:OZARK PHYSICAL THERAPY LLP
Entity Type:Organization
Organization Name:OZARK PHYSICAL THERAPY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:573-686-4209
Mailing Address - Street 1:2725 N WESTWOOD BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2346
Mailing Address - Country:US
Mailing Address - Phone:573-686-5510
Mailing Address - Fax:573-686-6846
Practice Address - Street 1:2725 N WESTWOOD BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2346
Practice Address - Country:US
Practice Address - Phone:573-686-5510
Practice Address - Fax:573-686-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626235204Medicaid