Healthcare Provider Details

I. General information

NPI: 1316697345
Provider Name (Legal Business Name): KATIE LOUISE RIEDELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N DEAN AVE STE 102
RAYMORE MO
64083-8398
US

IV. Provider business mailing address

22120 MIDLAND DR STE 1
SHAWNEE KS
66226-3554
US

V. Phone/Fax

Practice location:
  • Phone: 816-441-5656
  • Fax: 913-745-4352
Mailing address:
  • Phone: 913-351-2710
  • Fax: 913-745-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026018143
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: