Healthcare Provider Details

I. General information

NPI: 1841121563
Provider Name (Legal Business Name): CAROLINE NELSON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE NELSON PT, DPT

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 SW MARKET ST
LEES SUMMIT MO
64081-2904
US

IV. Provider business mailing address

1321 SW MARKET ST
LEES SUMMIT MO
64081-2904
US

V. Phone/Fax

Practice location:
  • Phone: 816-607-7180
  • Fax:
Mailing address:
  • Phone: 816-607-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026023159
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: