Healthcare Provider Details

I. General information

NPI: 1326552993
Provider Name (Legal Business Name): PERFECT PELVIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2017
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE TUDOR RD STE 105
LEES SUMMIT MO
64086-5600
US

IV. Provider business mailing address

100 NE TUDOR RD STE 105
LEES SUMMIT MO
64086-5600
US

V. Phone/Fax

Practice location:
  • Phone: 816-607-3747
  • Fax: 816-607-3590
Mailing address:
  • Phone: 816-607-3747
  • Fax: 816-607-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number116747
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE ANN RUSH
Title or Position: OWNER
Credential: PT
Phone: 816-806-7749