1467250852 NPI number — JEFFERSON PALO PT, DPT

Table of content: MRS. LISA RUGARBER LPC (NPI 1528763935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467250852 NPI number — JEFFERSON PALO PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALO
Provider First Name:
JEFFERSON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PALO
Provider Other First Name:
JEFF
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467250852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3119 NE 59TH TER APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLADSTONE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64119-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-785-4467
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-691-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2025005925 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)