Provider Demographics
NPI:1992836803
Name:ADULT DAY ACTIVITY PERSONAL TRAINING INC
Entity Type:Organization
Organization Name:ADULT DAY ACTIVITY PERSONAL TRAINING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-686-8095
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-7705
Mailing Address - Country:US
Mailing Address - Phone:573-686-8095
Mailing Address - Fax:
Practice Address - Street 1:101 BUTLER COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901
Practice Address - Country:US
Practice Address - Phone:573-686-8095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251S00000XAgenciesCommunity/Behavioral Health