Bolivar Physical Therapy Center, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BOLIVAR PHYSICAL THERAPY CENTER, LLC

Practice address

1028 W Broadway St Ste a
Bolivar, MO 65613-1809

Phone

(417) 777-2888

Fax

(417) 777-4597

NPI assigned

Aug 12, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William Jansen Vanhoornbeek, PTNPI 1538171368

Title

Owner / Member

Phone

(417) 777-2888

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 5

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.

• William Jansen Vanhoornbeek, PT

  • Physical Therapist
  • Bolivar, MO
  • NPI 1538171368
  Medicare reassignment NPD Authorized official
• Ira Jason Brown, DPT

  • Physical Therapist
  • Bolivar, MO
  • NPI 1619230489
  NPD (past)
• Herbert Jones Haman, DPT

  • Sports Physical Therapist
  • Bolivar, MO
  • NPI 1427060250
  NPD (past)
• Sarah Ann Jones, PT

  • Pediatric Physical Therapist
  • Bolivar, MO
  • NPI 1013181189

  Pediatrics

  NPD (past)
• Thomas James Sneed, DPT

  • Physical Therapist
  • Bolivar, MO
  • NPI 1073525804
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366454191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 W BROADWAY ST STE A",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131809",
            "telephone_number": "417-777-2888",
            "fax_number": "417-777-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 W BROADWAY ST STE A",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131809",
            "telephone_number": "417-777-2888",
            "fax_number": "417-777-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLIVAR PHYSICAL THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "VANHOORNBEEK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JANSEN",
        "authorized_official_title_or_position": "OWNER / MEMBER",
        "authorized_official_telephone_number": "417-777-2888",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "487223604",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505458208",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MO GROUP ID",
            "identifier": "201276",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bolivar Family Care Center
• Bolivar Family Care Center, LLC
• Bolivar Medical Center, Inc
• Bolivar Medical Center, Inc.
• Bolivar OB/GYN
• Bolivar R-1 Schools
• Bolivar R0I
• Bolivar Smiles Dentistry, LLC
• Bolivar Vision, LLC (Vision Source Bolivar)
• John A Boullier, MD

• Physical Therapist in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.