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General NPI Number Information
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NPI Number | 1780553206
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Entity Type | Organization
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Legal Business Name | IMPACT THERAPY LLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 10327 W 84TH TER
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City | LENEXA
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State | KS
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Zip | 66214-1639
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Country | US
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Telephone | 815-207-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 10327 W 84TH TER
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City | LENEXA
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State | KS
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Zip | 66214-1639
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Country | US
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Telephone | 815-207-0124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN LIGESKI
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Credential |
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Telephone | 815-207-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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