Healthcare Provider Details

I. General information

NPI: 1215891734
Provider Name (Legal Business Name): CONNOR JONAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 NW PAMELA BLVD
GRAIN VALLEY MO
64029-7844
US

IV. Provider business mailing address

1207 NW PAMELA BLVD
GRAIN VALLEY MO
64029-7844
US

V. Phone/Fax

Practice location:
  • Phone: 816-867-6022
  • Fax:
Mailing address:
  • Phone: 816-867-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2025004394
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: