Organization
STARZ PEDIATRIC THERAPY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEE NEWSOM PT (PHYSICAL THERAPIST, OWNER)
(816) 726-7337
Entity
Organization
Contact information
Practice address
640 NW JEFFERSON ST, GRAIN VALLEY, MO 64029-8278
(816) 726-7337
(816) 847-0218
Mailing address
1302 NW PERSIMMON DR, GRAIN VALLEY, MO 64029-8628
(816) 726-7337
(816) 847-0218
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518261320
—
MO
Enumeration date
01/07/2011
Last updated
08/28/2012
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