Healthcare Provider Details

I. General information

NPI: 1073565149
Provider Name (Legal Business Name): CHAD E HELMER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 NE 96TH ST STE A
LIBERTY MO
64068-7174
US

IV. Provider business mailing address

17134 BEL RAY PL
BELTON MO
64012-5331
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-0775
  • Fax: 816-792-0776
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number112594
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: