Organization
PHYSICAL THERAPY CLINIC OF AVA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MYLENE S. BAGUIO R.P.T. (SECRETARY / 50 OWNER)
(417) 683-3380
Entity
Organization
Contact information
Practice address
1307 HADEN STREET, AVA, MO 65608-5105
(417) 683-3380
(417) 683-3386
Mailing address
1307 HADEN STREET, AVA, MO 65608-5105
(417) 683-3380
(417) 683-3386
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
R0891
MO
261QP2000X
Physical Therapy Clinic/Center
Primary
R0933
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
756697306
—
MO
Enumeration date
05/25/2010
Last updated
02/03/2022
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