Healthcare Provider Details

I. General information

NPI: 1205337037
Provider Name (Legal Business Name): MID AMERICA BALANCE INSTITUTE OF CLAY PLATTE COUNTY MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 NE 91ST ST
KANSAS CITY MO
64155-3329
US

IV. Provider business mailing address

4900 S ARROWHEAD DR STE B
INDEPENDENCE MO
64055-6990
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-1456
  • Fax:
Mailing address:
  • Phone: 816-795-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEE WOODWARD
Title or Position: OWNER, MANAGER
Credential: MPT
Phone: 816-795-6999