Healthcare Provider Details

I. General information

NPI: 1063421667
Provider Name (Legal Business Name): SUSAN Y HAUSHEER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S BROADWAY ST
OAK GROVE MO
64075-8102
US

IV. Provider business mailing address

1904 NW HEDGEWOOD DR
GRAIN VALLEY MO
64029-7214
US

V. Phone/Fax

Practice location:
  • Phone: 816-690-8516
  • Fax: 816-690-6252
Mailing address:
  • Phone: 816-220-3700
  • Fax: 816-220-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR1245
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: