Healthcare Provider Details

I. General information

NPI: 1588586929
Provider Name (Legal Business Name): CALEB M DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 NW LEGACY DR
KANSAS CITY MO
64155-2894
US

IV. Provider business mailing address

14105 W 72ND TER
SHAWNEE KS
66216-3792
US

V. Phone/Fax

Practice location:
  • Phone: 816-436-6386
  • Fax:
Mailing address:
  • Phone: 816-436-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1404342
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2025038012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: