Provider Demographics
NPI:1457396756
Name:PHYSICAL THERAPY OF HIGGINSVILLE
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF HIGGINSVILLE
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 1:720 FAIRGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1638
Mailing Address - Country:US
Mailing Address - Phone:660-584-7801
Mailing Address - Fax:660-584-8619
Practice Address - Street 1:720 FAIRGROUND AVE
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1638
Practice Address - Country:US
Practice Address - Phone:660-584-7801
Practice Address - Fax:660-584-8619
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
MO29748028OtherBCBSKC
MOR210000Medicare PIN