Healthcare Provider Details

I. General information

NPI: 1730214149
Provider Name (Legal Business Name): CHRISTY ROSE PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTY ROSE JOANNES

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 NW MOORE RD
KANSAS CITY MO
64153-2218
US

IV. Provider business mailing address

PO BOX 101
FARLEY MO
64028-0101
US

V. Phone/Fax

Practice location:
  • Phone: 816-510-4691
  • Fax:
Mailing address:
  • Phone: 816-510-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2000154573
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: