1154501385 NPI number — ADVANCED PHYSICAL THERAPY AND SPORTS REHABILITATION, P.A.

Table of content: (NPI 1154501385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154501385 NPI number — ADVANCED PHYSICAL THERAPY AND SPORTS REHABILITATION, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PHYSICAL THERAPY AND SPORTS REHABILITATION, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154501385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 N.W. R.D. MIZE ROAD
Provider Second Line Business Mailing Address:
SUITE B203
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64014-2540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-220-0223
Provider Business Mailing Address Fax Number:
816-220-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6324 NW BARRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64154-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-741-4525
Provider Business Practice Location Address Fax Number:
816-220-9099
Provider Enumeration Date:
11/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEWMAN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-220-0223

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  01459 , 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)

  • Identifier: L560000A . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".