Healthcare Provider Details

I. General information

NPI: 1194592055
Provider Name (Legal Business Name): JESSICA PUTZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SOUTH MO 291 HIGHWAY
INDEPENDENCE MO
64057
US

IV. Provider business mailing address

2518 E OVID AVE
DES MOINES IA
50317-6024
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-9328
  • Fax: 816-373-9207
Mailing address:
  • Phone: 515-480-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP053163T
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: