Organization
BOLIVAR PHYSICAL THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM JANSEN VANHOORNBEEK PT (OWNER / MEMBER)
(417) 777-2888
Entity
Organization
Contact information
Practice address
1028 W BROADWAY ST STE A, BOLIVAR, MO 65613-1809
(417) 777-2888
(417) 777-4597
Mailing address
1028 W BROADWAY ST STE A, BOLIVAR, MO 65613-1809
(417) 777-2888
(417) 777-4597
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201276
BCBS OF MO GROUP ID
MO
05
—
487223604
—
MO
05
—
505458208
—
MO
Enumeration date
08/12/2006
Last updated
07/21/2022
Update your record
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