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General NPI Number Information
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NPI Number | 1043409766
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Entity Type | Organization
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Legal Business Name | NEW BALANCE KANSAS CITY
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 6607 W 119TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66209-2020
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Country | US
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Telephone | 913-696-1646
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Fax |
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Provider Business Mailing Address
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Address Line | 6607 W 119TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66209-2020
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Country | US
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Telephone | 913-696-1646
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PEDORTHIST
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Name | JULIA HILES
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Credential | C.PED
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Telephone | 913-696-1646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 013370
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License Number State | MO
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