Provider Demographics
NPI:1982823571
Name:TOTAL HEALTH AND REHABILITATION CENTER, PC
Entity Type:Organization
Organization Name:TOTAL HEALTH AND REHABILITATION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-642-9999
Mailing Address - Street 1:710 S BUSINESS 54
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1403
Mailing Address - Country:US
Mailing Address - Phone:573-642-9999
Mailing Address - Fax:573-642-8458
Practice Address - Street 1:710 S BUSINESS 54
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1403
Practice Address - Country:US
Practice Address - Phone:573-642-9999
Practice Address - Fax:573-642-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000173233111N00000X
208D00000X
MO2007022665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000031880Medicare PIN