Healthcare Provider Details

I. General information

NPI: 1528291572
Provider Name (Legal Business Name): BLUE VALLEY PHYSICAL THERAPY,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROADWAY ST SUITE 507
KANSAS CITY MO
64111-2658
US

IV. Provider business mailing address

6885 W 151ST ST SUITE 102
OVERLAND PARK KS
66223-2507
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-4848
  • Fax: 816-931-7392
Mailing address:
  • Phone: 913-897-1100
  • Fax: 913-897-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN TODD-COOPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 913-897-1100