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Organization

BST MORRIS 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
616 ATLANTIC AVE, BST MORRIS LLC, MORRIS, MN 56267-1380
(320) 585-5395
(320) 839-4196
Mailing address
309 WASHINGTON AVE, BST MORRIS LLC, ORTONVILLE, MN 56278-1357
(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

Other identifiers
Code
Description
Identifier
Issuer
State
05
842967700
MN
Enumeration date
10/10/2007
Last updated
03/10/2014
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