=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417317579
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL SAULSBERRY MS, ATC, LAT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2016
-----------------------------------------------------
Last Update Date | 03/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 NW MURRAY RD SUITE 112
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64081-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-282-5985
-----------------------------------------------------
Fax | 816-282-5988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 SE BLUE PKWY
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64063-1007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-282-5985
-----------------------------------------------------
Fax | 816-282-5988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 2011005786
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 24-00510
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------