Healthcare Provider Details

I. General information

NPI: 1073179925
Provider Name (Legal Business Name): JAIME MARIE MYERS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME MARIE LATENSER

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E GREGORY BLVD STE 200
KANSAS CITY MO
64114-1118
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 816-926-0222
  • Fax: 816-926-0277
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2019026048
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06140
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP003499T
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: