NPIMap

Organization Active NPI

Missouri State University PT Clinic

  • Physical Therapy Clinic/Center
  • Springfield, MO
National Provider Identifier
1003904079
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
MISSOURI STATE UNIVERSITY PT CLINIC
Practice address
606 E Cherry St
Room 100
Springfield, MO 65806-3401
Phone
(417) 836-3070
NPI assigned
Oct 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Vere Halliday, PTNPI 1578651550
Title
Clinic Director
Phone
(417) 836-3070

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

606 E Cherry St
Room 100
Springfield, MO 65806-3401

Mailing address

901 S National Ave
Springfield, MO 65897-0027
Phone (417) 836-3070

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

606 E Cherry St
Rm 100
Springfield, MO 65806
Phone (417) 836-3070

606 E Cherry St
Ste 100
Springfield, MO 65806
Phone (417) 836-3070

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003904079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 S NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658970027",
            "telephone_number": "417-836-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E CHERRY ST",
            "address_2": "ROOM 100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658063401",
            "telephone_number": "417-836-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI STATE UNIVERSITY PT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALLIDAY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "VERE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "417-836-3070",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.