Healthcare Provider Details

I. General information

NPI: 1730414970
Provider Name (Legal Business Name): SUE A. KLEIN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2368
US

IV. Provider business mailing address

3330 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2368
US

V. Phone/Fax

Practice location:
  • Phone: 816-886-2968
  • Fax:
Mailing address:
  • Phone: 816-886-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number11-01128
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11-01128
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberR0734
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: