# BST MARSHALL LLC

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

## Provider details

- **NPI number:** 1104987494
- **Authorized official:** WADE D VANDOVER PT (PRESIDENT)
- **Authorized official phone:** (320) 839-4152

## Contact information

- **Practice address:** 1420 E COLLEGE DR, SUITE 704, MARSHALL, MN 56258-2075
- **Practice address phone:** (507) 532-3393
- **Practice address fax:** (320) 839-4196
- **Mailing address:** 820 ROY STREET, BST MARSHALL LLC, ORTONVILLE, MN 56278-1138
- **Mailing address phone:** (320) 839-4271
- **Mailing address fax:** (320) 839-4196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 224Z00000X | Occupational Therapy Assistant | — | NULL | — |
| 224Z00000X | Occupational Therapy Assistant | — | — | — |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225200000X | Physical Therapy Assistant | — | NULL | — |
| 225200000X | Physical Therapy Assistant | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 03/12/2009