Healthcare Provider Details

I. General information

NPI: 1881942571
Provider Name (Legal Business Name): BOOST PHYSICAL THERAPY & SPORT PERFORANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 SE CENTURY DR
LEES SUMMIT MO
64081-3286
US

IV. Provider business mailing address

1254 SE CENTURY DR
LEES SUMMIT MO
64081-3286
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-1442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2012028521
License Number StateMO

VIII. Authorized Official

Name: TRAVIS NEFF
Title or Position: OWNER/PHYSICAL THERAPIST
Credential:
Phone: 816-795-0434