Provider Demographics
NPI:1982649208
Name:PHYSICAL THERAPY OF WARRENSBURG
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF WARRENSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MED RPT
Authorized Official - Phone:660-584-7801
Mailing Address - Street 1:540 E YOUNG AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1200
Mailing Address - Country:US
Mailing Address - Phone:660-747-0247
Mailing Address - Fax:660-747-0347
Practice Address - Street 1:540 E YOUNG AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1200
Practice Address - Country:US
Practice Address - Phone:660-747-0247
Practice Address - Fax:660-747-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-11-02
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
MO34248013OtherBCBSKC
MOR260000Medicare PIN