Organization Name: | PHYSICAL THERAPY CLINIC OF AVA, P.C. |
NPI Number: | 1023337391 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MYLENE S. BAGUIO (SECRETARY) |
Mailing Address: | Rr 1 Box 52 Ava |
State: | MO US |
Postal Code: | 656089703 |
Phone Number: | 4176833380 |
Fax Number: | 4716833386 |
NPI Enumeration Date: | 05/25/2010 |
NPI Last Update Date: | 05/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | R0891 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |