Healthcare Provider Details

I. General information

NPI: 1780553206
Provider Name (Legal Business Name): IMPACT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10327 W 84TH TER
LENEXA KS
66214-1639
US

IV. Provider business mailing address

10327 W 84TH TER
LENEXA KS
66214-1639
US

V. Phone/Fax

Practice location:
  • Phone: 815-207-0124
  • Fax:
Mailing address:
  • Phone: 815-207-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN LIGESKI
Title or Position: OWNER
Credential:
Phone: 815-207-0124