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General NPI Number Information
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NPI Number | 1255728986
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Entity Type | Organization
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Legal Business Name | OPTIMUM PHYSICAL THERAPY & PERFORMANCE CENTER, LLC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 5501 NW 62ND TER STE 102
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City | KANSAS CITY
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State | MO
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Zip | 64151-2411
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Country | US
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Telephone | 816-547-6140
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 NW 86TH CT
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City | KANSAS CITY
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State | MO
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Zip | 64154-1283
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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 | CEO
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Name | DANIEL S JACKSON
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Credential | DPT
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Telephone | 816-547-6140
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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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