Healthcare Provider Details

I. General information

NPI: 1568809556
Provider Name (Legal Business Name): MISSOURI VALLEY THERAPY COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 N GRANBY AVE
KANSAS CITY MO
64154-1235
US

IV. Provider business mailing address

8575 N GRANBY AVE
KANSAS CITY MO
64154-1235
US

V. Phone/Fax

Practice location:
  • Phone: 816-468-4015
  • Fax: 816-468-4010
Mailing address:
  • Phone: 816-468-4015
  • Fax: 816-468-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number873-27
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3820-24
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1183-19
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number948-19
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3041-154
License Number StateWI
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number654-26
License Number StateWI

VIII. Authorized Official

Name: MS. HEATHER NICHOLE MACKEY
Title or Position: DIRECTOR OF OPERATIONS
Credential: PTA
Phone: 816-547-9248