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NPI Code Detail

MEDICARE: RONALD C WILLEKE MPT

MEDICARE:   RONALD C WILLEKE  MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist115000MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
134345075OTHERMOBCBS

General Provider Information

NPI Number : 1093754020
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD C WILLEKE MPT
Provider Business Mailing Address
First Line : 4240 BLUE RIDGE BLVD
Second Line : SUITE 515
City : KANSAS CITY
State : MO
Zip : 64133-1713
Country : US
Telephone Number : 816-353-0060
Fax Number : 816-353-0070
Provider Business Practice Location Address
First Line : 4240 BLUE RIDGE BLVD
Second Line : SUITE 515
City : KANSAS CITY
State : MO
Zip : 64133-1713
Country : US
Telephone Number : 816-353-0060
Fax Number : 816-353-0070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 10/12/2012

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Directions to “ RONALD C WILLEKE MPT” Practice Location

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