Provider Demographics
NPI:1942467675
Name:APTITUDE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:APTITUDE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:417-890-7787
Mailing Address - Street 1:1342 E PRIMROSE STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4224
Mailing Address - Country:US
Mailing Address - Phone:417-890-7787
Mailing Address - Fax:417-890-9397
Practice Address - Street 1:1342 E PRIMROSE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4224
Practice Address - Country:US
Practice Address - Phone:417-890-7787
Practice Address - Fax:417-890-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2014-07-28
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
MO1942467675Medicaid