Healthcare Provider Details

I. General information

NPI: 1477911097
Provider Name (Legal Business Name): CHENIN MARIE ROUDEBUSH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHENIN MARIE YOUNG

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MAIN ST
KANSAS CITY MO
64111-2645
US

IV. Provider business mailing address

3215 MAIN ST
KANSAS CITY MO
64111-2645
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026038783
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: