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General NPI Number Information
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NPI Number | 1154951176
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Entity Type | Organization
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Legal Business Name | MIGHTY KIDS PEDIATRIC THERAPY
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 829 HWY 150
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City | LEE'S SUMMIT
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State | MO
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Zip | 64082-6408
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Country | US
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Telephone | 816-352-9271
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Fax |
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Provider Business Mailing Address
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Address Line | 914 SW GEORGETOWN DR
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City | LEES SUMMIT
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State | MO
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Zip | 64082-4681
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Country | US
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Telephone | 816-352-9271
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. JEREMY ADAM BROWN
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Credential |
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Telephone | 816-352-9271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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