Individual
LISA LIF I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
455 E 81ST ST, KANSAS CITY, MO 64131-2122
(816) 506-4635
Mailing address
455 E 81ST STREET, KANSAS CITY, MO 64131
(816) 506-4635
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116832
MO
225200000X
Physical Therapy Assistant
14-00240
KS
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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