Healthcare Provider Details

I. General information

NPI: 1417350398
Provider Name (Legal Business Name): LARRY MATTHEW HUFF ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STATE LINE RD
KANSAS CITY MO
64112-1157
US

IV. Provider business mailing address

10501 NW 87TH TER
KANSAS CITY MO
64153-3691
US

V. Phone/Fax

Practice location:
  • Phone: 816-936-1576
  • Fax:
Mailing address:
  • Phone: 816-529-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2007022758
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: