Healthcare Provider Details

I. General information

NPI: 1285113225
Provider Name (Legal Business Name): EMPOWERME REHABILITATION MO AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 SE BLUE PKWY
LEES SUMMIT MO
64063-1007
US

IV. Provider business mailing address

120 S CENTRAL AVE
CLAYTON MO
63105-1705
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-0101
  • Fax:
Mailing address:
  • Phone: 314-485-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JANAKA DIAS
Title or Position: PRESIDENT
Credential:
Phone: 314-485-7979