Healthcare Provider Details

I. General information

NPI: 1053685404
Provider Name (Legal Business Name): LAURA JARVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 NW PRAIRIE VIEW RD
PLATTE CITY MO
64079-7627
US

IV. Provider business mailing address

1520 E 23RD ST S SUITE D
INDEPENDENCE MO
64055-1600
US

V. Phone/Fax

Practice location:
  • Phone: 816-858-2368
  • Fax: 816-858-2214
Mailing address:
  • Phone: 816-836-0800
  • Fax: 816-836-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2011031114
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: