Organization
SELECT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESHARA LEWIS (CREDENTIALING COORDINATOR)
(469) 609-5235
Entity
Organization
Contact information
Practice address
2301 S MO 291 HWY, INDEPENDENCE, MO 64057
(816) 373-9728
Mailing address
1650 BROADWAY BLVD, KANSAS CITY, MO 64108-1208
(816) 842-2020
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/16/2021
Last updated
07/16/2021
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