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General NPI Number Information
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NPI Number | 1881942571
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Entity Type | Organization
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Legal Business Name | BOOST PHYSICAL THERAPY & SPORT PERFORANCE
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 1254 SE CENTURY DR
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City | LEES SUMMIT
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State | MO
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Zip | 64081-3286
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Country | US
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Telephone | 816-524-1442
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Fax |
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Provider Business Mailing Address
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Address Line | 1254 SE CENTURY DR
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City | LEES SUMMIT
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State | MO
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Zip | 64081-3286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | TRAVIS NEFF
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Credential |
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Telephone | 816-795-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 2012028521
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License Number State | MO
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