Provider Demographics
NPI:1659312619
Name:PHYSICAL THERAPY SPECIALIST CLINIC, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALIST CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:SHEID
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:417-256-5669
Mailing Address - Street 1:1480 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2010
Mailing Address - Country:US
Mailing Address - Phone:417-256-5669
Mailing Address - Fax:417-256-5699
Practice Address - Street 1:1480 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2010
Practice Address - Country:US
Practice Address - Phone:417-256-5669
Practice Address - Fax:417-256-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005362224Z00000X
MO2003016144225100000X
MO01442225100000X
MO107429225100000X
MO2006029256225200000X
MO116745225200000X
MO2001031039225200000X
MO1070412255A2300X
MO1185412255A2300X
MO1096472255A2300X
MO1140702255A2300X
MO2003019075225X00000X
MO2001033005225X00000X
MO2006020966235Z00000X
MO115072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31277OtherBC/BS OF MO
MO497721142SHEOtherPREMIER
MO792288OtherFIRST HEALTH
MO336556OtherHEALTHLINK
MO507432102Medicaid
MO973358OtherUNITED HEALTH CARE
MO507432102Medicaid