Princeton Physical Therapy and Sports Medicine LLC
Organization Active NPI Physical Therapist · Princeton, MO
NPI 1871662767 · NPPES record last updated Oct 1, 2008
Key facts
- NPI
- 1871662767
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- 117457 (MO)
- Legal business name
- PRINCETON PHYSICAL THERAPY AND SPORTS MEDICINE LLC
- Practice address
- 807 E Hickland St
Princeton, MO 64673-1227 - Phone
- (660) 748-3600
- Fax
- (660) 748-3605
- NPI assigned
- Nov 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy Lee McDaniel, MS, PT
- Title
- Owner-Physical Therapy
- Phone
- (660) 748-3600
Practitioners 2
-
Amy Lee McDaniel, MS PT
-
Mary Katherine Easter, CPO, OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081003000034 | MO | Part B Supplier - Clinic/Group Practice | 7113095274 |
Receives reassigned benefits from 1 practitioner Practice locations: Princeton, MO |
National Provider Directory
Locations
400 N Stewart St
Princeton, MO 64673
Phone (660) 748-3600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 117457 | MO | Yes |
Addresses
Primary practice location
807 E Hickland St
Princeton, MO 64673-1227
Mailing address
807 E Hickland St
Princeton, MO 64673-1227
Phone (660) 748-3600
Other providers in Princeton, MO
- Mercer County Ambulance District
- Mercer County Ambulance District
- Mercer County Health Department
- Pearl'S II Eden for Elders LLC
- Pearls Residential Care LLC
- Amy Rhoades
- Saint Luke'S Hospital of Trenton
- Philip Stephen Staehling
- Kelli Ann Stark
- Tammy Hart, MD, PC
All providers in Princeton, 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 Oct 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.