Healthcare Provider Details

I. General information

NPI: 1033690367
Provider Name (Legal Business Name): CARL THOMAS KRIZ PHYSICAL THERAPIST A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
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

6501 NW SIOUX DR
KANSAS CITY MO
64152-3820
US

V. Phone/Fax

Practice location:
  • Phone: 816-436-8575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01045
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number115305
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: