# MISSOURI STATE UNIVERSITY PT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003904079
- **Authorized official:** MICHAEL VERE HALLIDAY PT (CLINIC DIRECTOR)
- **Authorized official phone:** (417) 836-3070

## Contact information

- **Practice address:** 606 E CHERRY ST, ROOM 100, SPRINGFIELD, MO 65806-3401
- **Practice address phone:** (417) 836-3070
- **Mailing address:** 901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0027
- **Mailing address phone:** (417) 836-3070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 08/22/2020