Individual
MICHELE R IVANS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
2425 NW PRAIRIE VIEW RD, PLATTE CITY, MO 64079-7627
(816) 858-3250
(816) 858-3253
Mailing address
942 ROSE AVE, BURLINGTON, CO 80807-1815
(719) 346-6050
(719) 346-5509
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11-03404
KS
225100000X
Physical Therapist
Primary
2005003641
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35214014
BLUE CROSS & BLUE SHIELD
MO
Enumeration date
01/17/2006
Last updated
08/19/2020
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