Provider Demographics
NPI:1902178106
Name:MCDOUGLE, ROBERT EUGENE (LPTA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EUGENE
Last Name:MCDOUGLE
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22865 COUNTYLINE RD
Mailing Address - Street 2:
Mailing Address - City:SHELL KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:65747-7503
Mailing Address - Country:US
Mailing Address - Phone:417-858-2421
Mailing Address - Fax:
Practice Address - Street 1:22865 COUNTYLINE RD
Practice Address - Street 2:
Practice Address - City:SHELL KNOB
Practice Address - State:MO
Practice Address - Zip Code:65747-7503
Practice Address - Country:US
Practice Address - Phone:417-858-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116059225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant