Organization
FARMINGTON SPORTS AND REHABILITATION JOINT VENTURE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHERINE A DULLE (PRESIDENT OF PARTNERSHIP)
(573) 506-8800
Entity
Organization
Contact information
Practice address
602 MAPLE VALLEY DR, FARMINGTON, MO 63640-1976
(573) 756-2999
(573) 756-6195
Mailing address
602 MAPLE VALLEY DR, FARMINGTON, MO 63640-1976
(573) 756-2999
(573) 756-6195
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
578631509
—
MO
Enumeration date
01/15/2007
Last updated
01/06/2020
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