Organization Name: | MID AMERICA REHAB |
NPI Number: | 1306171053 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMANDA JO MYERS (PHYSICAL THERAPIST) |
Mailing Address: | 206 Hospital Ln Suite 100 Perryville |
State: | MO US |
Postal Code: | 637751276 |
Phone Number: | 5737683349 |
Fax Number: | |
NPI Enumeration Date: | 10/14/2009 |
NPI Last Update Date: | 10/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |