Healthcare Provider Details

I. General information

NPI: 1447522586
Provider Name (Legal Business Name): JOSEPH MICHAEL WHETSTONE ATC, LAT, CES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SE BLUE PKWY SUITE 230
LEES SUMMIT MO
64063-1041
US

IV. Provider business mailing address

2000 SE BLUE PKWY SUITE 230
LEES SUMMIT MO
64063-1041
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2840
  • Fax: 816-525-2481
Mailing address:
  • Phone: 816-525-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2865
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2013028790
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: