Organization
HAVEN PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RAY PT (CEO)
(417) 581-1234
Entity
Organization
Contact information
Practice address
1114 W JACKSON ST, OZARK, MO 65721-9164
(417) 581-1234
Mailing address
850 N 25TH ST, OZARK, MO 65721-9164
(417) 581-1234
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
RO570
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740586940
—
MO
Enumeration date
02/27/2017
Last updated
08/01/2017
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