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General NPI Number Information
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NPI Number | 1871957522
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 373 W 101ST TER STE 200
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City | KANSAS CITY
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State | MO
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Zip | 64114-4408
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Country | US
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Telephone | 816-739-0884
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Fax | 816-795-3366
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Provider Business Mailing Address
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Address Line | 4900 S ARROWHEAD DR STE B
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City | INDEPENDENCE
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State | MO
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Zip | 64055-6952
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Country | US
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Telephone | 816-739-0884
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Fax | 816-795-3366
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL WOODWARD
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Credential | MPT
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Telephone | 816-739-0884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 115120
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License Number State | MO
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