Healthcare Provider Details

I. General information

NPI: 1841392123
Provider Name (Legal Business Name): HEATHER GOIST FOLEY RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER G FOLEY RPT

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MAIN ST STE 202
KANSAS CITY MO
64111-1946
US

IV. Provider business mailing address

3215 MAIN ST
KANSAS CITY MO
64111-2645
US

V. Phone/Fax

Practice location:
  • Phone: 816-472-1800
  • Fax:
Mailing address:
  • Phone: 816-472-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number11-02189
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number109154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: