Healthcare Provider Details

I. General information

NPI: 1720767031
Provider Name (Legal Business Name): KYLE ORTMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NE COLUMBUS ST
LEES SUMMIT MO
64086-2977
US

IV. Provider business mailing address

501 NW VESPER ST STE A
BLUE SPRINGS MO
64014-2745
US

V. Phone/Fax

Practice location:
  • Phone: 816-427-5300
  • Fax: 816-927-6342
Mailing address:
  • Phone: 816-427-5300
  • Fax: 816-927-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: