Provider Demographics
NPI:1851579601
Name:PHYSICAL THERAPY OF JOPLIN
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF JOPLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:417-624-7400
Mailing Address - Street 1:1227 E 32ND ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2811
Mailing Address - Country:US
Mailing Address - Phone:417-624-7400
Mailing Address - Fax:417-624-7403
Practice Address - Street 1:1227 E 32ND ST
Practice Address - Street 2:SUITE 7
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2811
Practice Address - Country:US
Practice Address - Phone:417-624-7400
Practice Address - Fax:417-624-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000572905OtherBCBS ANTHEM
MO000000572905OtherBCBS ANTHEM