MEDICARE: BRYSON ANDREW WAITKOSS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2024006192	MO

General Provider Information

NPI Number	:	1144085085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYSON ANDREW WAITKOSS DPT

Provider Business Mailing Address
First Line	:	1213 N BELT HWY STE H
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2485
Country	:	US
Telephone Number	:	816-279-7778
Fax Number	:	816-279-8788

Provider Business Practice Location Address
First Line	:	1213 N BELT HWY STE H
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2485
Country	:	US
Telephone Number	:	816-279-7778
Fax Number	:	816-279-8788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/20/2024

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