Individual
MR. GARY DWAYNE EICHENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
102 S FORREST AVE, LIBERTY, MO 64068-1908
(515) 341-2721
Mailing address
8800 W 75TH ST, STE. 350, SHAWNEE MISSION, KS 66204-2205
(913) 362-8317
(913) 362-0169
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2010031806
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12198273
CAQH NUMBER
MO
Enumeration date
03/30/2011
Last updated
06/13/2017
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