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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