Organization
PHYSICAL THERAPY, LLC
Active
Other names
Republic Medical Supply & Republic Physical Therapy & Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETERPAUL MAYO CHANLIONGCO P.T. (PRESIDENT)
(417) 732-2344
Entity
Organization
Contact information
Practice address
213 US HIGHWAY 60 W, REPUBLIC, MO 65738-1432
(417) 732-2344
(417) 732-6014
Mailing address
213 US HIGHWAY 60 W, REPUBLIC, MO 65738-1432
(417) 732-2344
(417) 732-6014
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
100395
MO
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202177
ANTHEM BLUE CROSS BLUE SH
MO
01
—
610616900
DEPARTMENT OF LABOR
MO
Enumeration date
10/12/2006
Last updated
02/03/2010
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