Healthcare Provider Details

I. General information

NPI: 1518261320
Provider Name (Legal Business Name): STARZ PEDIATRIC THERAPY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NW JEFFERSON ST
GRAIN VALLEY MO
64029-8278
US

IV. Provider business mailing address

1302 NW PERSIMMON DR
GRAIN VALLEY MO
64029-8628
US

V. Phone/Fax

Practice location:
  • Phone: 816-726-7337
  • Fax: 816-847-0218
Mailing address:
  • Phone: 816-726-7337
  • Fax: 816-847-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEE NEWSOM
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: PT
Phone: 816-726-7337