Healthcare Provider Details

I. General information

NPI: 1871708172
Provider Name (Legal Business Name): SPINE & EXTREMITY REHABILITATION CENTER OF KANSAS CITY NORTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 N MAIN ST
KANSAS CITY MO
64155-2426
US

IV. Provider business mailing address

8409 N MAIN ST
KANSAS CITY MO
64155-2426
US

V. Phone/Fax

Practice location:
  • Phone: 816-420-0286
  • Fax: 816-420-8207
Mailing address:
  • Phone: 816-420-0286
  • Fax: 816-420-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMO

VIII. Authorized Official

Name: ROBERT A MITCHELL
Title or Position: MANAGER, OWNER, PHYSICAL THERAPIST
Credential: PT
Phone: 816-505-3422