Organization
BOOST SPORTS PERFORMANCE, LLC
Active
Other names
Boost Physical Therapy & Sports Performance
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA LEE LINVILLE PT, DPT, SCS (OWNER)
(816) 407-1249
Entity
Organization
Contact information
Practice address
1254 SE CENTURY DR, LEES SUMMIT, MO 64081-3286
(816) 524-1442
(816) 524-1445
Mailing address
1254 SE CENTURY DR, LEES SUMMIT, MO 64081-3286
(816) 524-1442
(816) 524-1445
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA1102
MEDICARE PTAN
MO
01
—
MA5234
MEDICARE PTAN
MO
Enumeration date
06/02/2008
Last updated
11/01/2023
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