# BOOST PHYSICAL THERAPY AND SPORTS PERFORMANCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578913380
- **Authorized official:** CLINT HOOPER (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (940) 390-7222

## Contact information

- **Practice address:** 1102 W 101ST TER APT F, KANSAS CITY, MO 64114-4289
- **Practice address phone:** (314) 974-7669
- **Mailing address:** 1102 W 101ST TER APT F, KANSAS CITY, MO 64114-4289

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 11-05331 | KS | Yes |

## Other

- **Enumeration date:** 06/13/2016
- **Last updated:** 06/13/2016