Healthcare Provider Details

I. General information

NPI: 1568128544
Provider Name (Legal Business Name): ERIC ADAM ARCHER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7358 N SHANNON AVE
KANSAS CITY MO
64152-2391
US

IV. Provider business mailing address

7358 N SHANNON AVE
KANSAS CITY MO
64152-2391
US

V. Phone/Fax

Practice location:
  • Phone: 816-820-6161
  • Fax:
Mailing address:
  • Phone: 816-820-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2011017512
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2011017512
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: