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General NPI Number Information
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NPI Number | 1053725812
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Entity Type | Organization
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Legal Business Name | INSPIRED BODY THERAPY LLC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 309 PARK LN UNIT M
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City | ODESSA
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State | MO
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Zip | 64076-1676
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Country | US
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Telephone | 816-565-2490
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Fax |
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Provider Business Mailing Address
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Address Line | 309 PARK LN UNIT M
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City | ODESSA
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State | MO
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Zip | 64076-1676
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Country | US
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Telephone | 816-565-2490
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD K RAUGEWITZ
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Credential | P.T.
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Telephone | 816-565-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2011035532
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License Number State | MO
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