Healthcare Provider Details

I. General information

NPI: 1861258493
Provider Name (Legal Business Name): CHRISTAL S SCOTT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTAL SHEREE SMILEY PTA

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 W 87TH STREET PKWY
LENEXA KS
66215-5372
US

IV. Provider business mailing address

1820 ARBOR TRL
LIBERTY MO
64068-7187
US

V. Phone/Fax

Practice location:
  • Phone: 620-209-5443
  • Fax:
Mailing address:
  • Phone: 770-548-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2011027294
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04312
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: