Healthcare Provider Details

I. General information

NPI: 1962767061
Provider Name (Legal Business Name): RESTORE MUSCLE AND JOINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 NW BARRY RD
KANSAS CITY MO
64154-1100
US

IV. Provider business mailing address

4119 NW BARRY RD
KANSAS CITY MO
64154-1100
US

V. Phone/Fax

Practice location:
  • Phone: 816-452-4488
  • Fax: 816-452-4491
Mailing address:
  • Phone: 816-452-4488
  • Fax: 816-452-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TROY AARON PEARSON
Title or Position: OWNER
Credential:
Phone: 816-686-4551