Organization
SPORT AND SPINE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY MORRIS (MANAGER)
(573) 443-0225
Entity
Organization
Contact information
Practice address
303 N KEENE ST, STE 102, COLUMBIA, MO 65201-7193
(573) 443-0225
Mailing address
303 N KEENE ST, STE 102, COLUMBIA, MO 65201-7193
(573) 443-0225
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
2011030640
MO
Other
Enumeration date
07/31/2014
Last updated
07/31/2014
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