Organization
BST MARSHALL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WADE D VANDOVER PT (PRESIDENT)
(320) 839-4152
Entity
Organization
Contact information
Practice address
1420 E COLLEGE DR, SUITE 704, MARSHALL, MN 56258-2075
(507) 532-3393
(320) 839-4196
Mailing address
820 ROY STREET, BST MARSHALL LLC, ORTONVILLE, MN 56278-1138
(320) 839-4271
(320) 839-4196
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/12/2006
Last updated
03/12/2009
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