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General NPI Number Information
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NPI Number | 1518261320
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Entity Type | Organization
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Legal Business Name | STARZ PEDIATRIC THERAPY NETWORK
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 640 NW JEFFERSON ST
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City | GRAIN VALLEY
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State | MO
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Zip | 64029-8278
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Country | US
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Telephone | 816-726-7337
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Fax | 816-847-0218
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Provider Business Mailing Address
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Address Line | 1302 NW PERSIMMON DR
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City | GRAIN VALLEY
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State | MO
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Zip | 64029-8628
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Country | US
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Telephone | 816-726-7337
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Fax | 816-847-0218
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | STACEE NEWSOM
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Credential | PT
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Telephone | 816-726-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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