Healthcare Provider Details

I. General information

NPI: 1962272674
Provider Name (Legal Business Name): PRESTIGE HAND AND PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 NE TROON DR STE A
LEES SUMMIT MO
64064-1988
US

IV. Provider business mailing address

3730 NE TROON DR
LEES SUMMIT MO
64064-1988
US

V. Phone/Fax

Practice location:
  • Phone: 816-602-5046
  • Fax:
Mailing address:
  • Phone: 816-602-5056
  • Fax: 816-272-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ZWERENZ
Title or Position: OWNER
Credential: OT
Phone: 816-305-6414