Provider Demographics
NPI:1629058219
Name:ORTHOPEDIC REHAB SPECIALTY GROUP
Entity Type:Organization
Organization Name:ORTHOPEDIC REHAB SPECIALTY GROUP
Other - Org Name:PLATTE COUNTY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELLING
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MOMT
Authorized Official - Phone:816-858-3250
Mailing Address - Street 1:2425 NW PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7627
Mailing Address - Country:US
Mailing Address - Phone:816-858-3250
Mailing Address - Fax:816-858-3253
Practice Address - Street 1:2425 NW PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7627
Practice Address - Country:US
Practice Address - Phone:816-858-3250
Practice Address - Fax:816-858-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-6613Medicare ID - Type Unspecified