Organization
SPORT REHAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIKAY L PORTELL MSPT/ATC (VICE PRESIDENT)
(573) 368-0999
Entity
Organization
Contact information
Practice address
906 N CEDAR ST, ROLLA, MO 65401-3350
(573) 368-0999
(573) 368-2777
Mailing address
906 N CEDAR ST, ROLLA, MO 65401-3350
(573) 368-0999
(573) 368-2777
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
05/09/2006
Last updated
08/09/2010
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