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General NPI Number Information
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NPI Number | 1003722448
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Entity Type | Organization
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Legal Business Name | MISSOURI FITNESS PHYSIO, LLC
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 900 NE DEERBROOK ST
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City | LEES SUMMIT
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State | MO
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Zip | 64086-8411
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Country | US
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Telephone | 855-749-7561
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Fax |
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Provider Business Mailing Address
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Address Line | 1714 CANTERBURY RD
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City | RALEIGH
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State | NC
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Zip | 27608-1110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARC DOUEK
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Credential |
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Telephone | 919-327-7697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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