Individual
GARY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
13830 S 71 HIGHWAY, GRANDVIEW, MO 64030
(816) 761-8088
Mailing address
510 CONCORD ST, BELTON, MO 64012-1809
(816) 322-2374
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117830
LICENSE#
MO
Enumeration date
11/07/2006
Last updated
07/23/2013
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