NPIMap

Organization Active NPI

Mid Missouri Physical Therapy

  • Physical Therapist
  • Macon, MO
National Provider Identifier
1891908612
Registry record updated Jul 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
02103 Issued in MO
Legal business name
MID MISSOURI PHYSICAL THERAPY
Practice address
2005 N. Missouri St.
Suite D
Macon, MO 63552-0381
Phone
(660) 385-6540
Fax
(660) 385-6542
NPI assigned
May 8, 2007
Last updated
Jul 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2009

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

Authorized official

Name
Paul Vincent Lane, P.T.NPI 1841316296
Title
Ceo
Phone
(660) 385-6540

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 02103 MO Primary

Addresses

Primary practice location

2005 N. Missouri St.
Suite D
Macon, MO 63552-0381

Mailing address

PO Box 381
Macon, MO 63552-0381
Phone (660) 385-6540

National Provider Directory

National Provider Directory

Locations

1706 Prospect Dr
Macon, MO 63552
Phone (660) 385-1006

2005 N Missouri St
Ste D
Macon, MO 63552
Phone (660) 385-6540

Practitioners & affiliated clinicians

Practitioners 8

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": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247788800000",
    "number": "1891908612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 381",
            "city": "MACON",
            "state": "MO",
            "postal_code": "635520381",
            "telephone_number": "660-385-6540",
            "fax_number": "660-385-6542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 N. MISSOURI ST.",
            "address_2": "SUITE D",
            "city": "MACON",
            "state": "MO",
            "postal_code": "635520381",
            "telephone_number": "660-385-6540",
            "fax_number": "660-385-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID MISSOURI PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2009-07-17",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-385-6540",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "02103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; 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.