Organization
MID MISSOURI PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL VINCENT LANE P.T. (CEO)
(660) 385-6540
Entity
Organization
Contact information
Practice address
2005 N. MISSOURI ST., SUITE D, MACON, MO 63552-0381
(660) 385-6540
(660) 385-6542
Mailing address
PO BOX 381, MACON, MO 63552-0381
(660) 385-6540
(660) 385-6542
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02103
MO
Other
Enumeration date
05/08/2007
Last updated
07/17/2009
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