Organization
MIGHTY KIDS PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY ADAM BROWN (DIRECTOR OF OPERATIONS)
(816) 352-9271
Entity
Organization
Contact information
Practice address
829 HWY 150, LEE'S SUMMIT, MO 64082-6408
(816) 352-9271
Mailing address
914 SW GEORGETOWN DR, LEES SUMMIT, MO 64082-4681
(816) 352-9271
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336789973
NPI
—
01
—
1649241779
NPI
—
Enumeration date
01/17/2020
Last updated
01/17/2020
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