Provider Demographics
NPI:1669796371
Name:WEST PLAINS PHYSICAL THERAPY INSTITUTE INC
Entity type:Organization
Organization Name:WEST PLAINS PHYSICAL THERAPY INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:417-255-2333
Mailing Address - Street 1:906 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2025
Mailing Address - Country:US
Mailing Address - Phone:417-255-2333
Mailing Address - Fax:417-255-2332
Practice Address - Street 1:906 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2025
Practice Address - Country:US
Practice Address - Phone:417-255-2333
Practice Address - Fax:417-255-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030214225700000X
MO113699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68955Medicare UPIN