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General NPI Number Information
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NPI Number | 1992091664
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Entity Type | Organization
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Legal Business Name | BIO-DYNAMIX PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 4812 NE 62ND ST
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City | KANSAS CITY
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State | MO
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Zip | 64119-5065
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Country | US
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Telephone | 816-695-7906
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Fax |
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Provider Business Mailing Address
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Address Line | 556 RUSH CREEK PKWY SUITE C
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City | LIBERTY
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State | MO
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Zip | 64068-9609
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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/DOCTOR OF PHYSICAL THERAPY
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Name | JOHN MANDACINA II
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Credential | DPT
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Telephone | 816-695-7906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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