Ira Jason Brown, DPT
Individual provider Active NPI Physical Therapist · Bolivar, MO
NPI 1619230489 · NPPES record last updated Jun 18, 2012
Key facts
- NPI
- 1619230489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2012016550 (MO)
- Practice address
- 850 E San Martin St
Bolivar, MO 65613-2897 - Phone
- (417) 777-2888
- NPI assigned
- Jun 18, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012016550 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bolivar Physical Therapy Center, LLC | Physical Therapist | Past | Accepting new patients |
| Oa Centers of Kansas City, LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2012016550 | MO | Yes |
Addresses
Primary practice location
850 E San Martin St
Bolivar, MO 65613-2897
Mailing address
4077 S 97TH Rd
Bolivar, MO 65613-8512
Phone (417) 777-5865
Other providers in Bolivar, MO
- Brian G. Hackleman, D.C., L.L.C.
- Rebecca L. Briggs
- Carmen Broadbent
- Jason Brooks
- Garry J Brown
- Courtney Marie Brummel
- Susan Kay Buchen
- Samuel Christian Buesking
- Mark J Bult
- Jennifer A Bushre
All providers in Bolivar, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.