# BST MORRIS LLC

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

## Provider details

- **NPI number:** 1124216536
- **Authorized official:** WADE D VANDOVER PT (PRESIDENT)
- **Authorized official phone:** (320) 839-4152

## Contact information

- **Practice address:** 616 ATLANTIC AVE, BST MORRIS LLC, MORRIS, MN 56267-1380
- **Practice address phone:** (320) 585-5395
- **Practice address fax:** (320) 839-4196
- **Mailing address:** 309 WASHINGTON AVE, BST MORRIS LLC, ORTONVILLE, MN 56278-1357
- **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:** 10/10/2007
- **Last updated:** 03/10/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 842967700 | — | MN |