Healthcare Provider Details

I. General information

NPI: 1467840918
Provider Name (Legal Business Name): MRS. JACQUELINE KLOIBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 CHESTNUT DR
KANSAS CITY MO
64137-3201
US

IV. Provider business mailing address

10425 CHESTNUT DR
KANSAS CITY MO
64137-3201
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-4444
  • Fax:
Mailing address:
  • Phone: 816-763-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number114077
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: