Healthcare Provider Details

I. General information

NPI: 1144157587
Provider Name (Legal Business Name): RTP SPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E YOUNG AVE STE 320C
WARRENSBURG MO
64093-1265
US

IV. Provider business mailing address

1675 NW 785TH RD
BATES CITY MO
64011-9110
US

V. Phone/Fax

Practice location:
  • Phone: 806-477-2437
  • Fax:
Mailing address:
  • Phone: 806-477-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CARVER
Title or Position: OWNER
Credential: DPT
Phone: 806-477-2437