Healthcare Provider Details

I. General information

NPI: 1295994630
Provider Name (Legal Business Name): MARY BETH NORSWORTHY CPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BETH GREATHOUSE CPTA

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ANTIOCH RD SUITE 430
MERRIAM KS
66204-1258
US

IV. Provider business mailing address

8118 NW FOREST DR
WEATHERBY LAKE MO
64152-1652
US

V. Phone/Fax

Practice location:
  • Phone: 913-652-9229
  • Fax: 913-652-9198
Mailing address:
  • Phone: 816-694-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2000152520
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: