Individual
TRI LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
4600 S NOLAND RD STE A, INDEPENDENCE, MO 64055-4797
(816) 313-2220
(816) 897-2390
Mailing address
24703 ALBERTI SONATA DR, KATY, TX 77493-3315
(816) 377-0775
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11-07365
KS
225100000X
Physical Therapist
1394668
TX
225100000X
Physical Therapist
Primary
2019020965
MO
Other
Enumeration date
09/20/2023
Last updated
08/25/2025
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