Organization
SPRINGFIELD PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADLEY T JOHNSON PT (OWNER MEMBER PHYSICAL THERAPIST)
(417) 888-0808
Entity
Organization
Contact information
Practice address
929 E MONTCLAIR, SUITE 104, SPRINGFIELD, MO 65807
(417) 888-0808
(417) 888-0811
Mailing address
929 E MONTCLAIR, SUITE 104, SPRINGFIELD, MO 65807
(417) 888-0808
(417) 888-0811
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
R1012
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169735
BCBS
MO
01
—
DC9496
RAILROAD MEDICARE
MO
Enumeration date
05/08/2006
Last updated
12/12/2011
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