=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467250852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFERSON PALO PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 CLAY EDWARDS DR
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-691-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3119 NE 59TH TER APT 2
-----------------------------------------------------
City | GLADSTONE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64119-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-785-4467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2025005925
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------