MEDICARE: ADVANCED PHYSICAL THERAPY AND SPORTS REHABILITATION, P.A.

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
1	261QP2000X	Physical Therapy Clinic/Center	01459	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L560000A	OTHER	MO	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1154501385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHYSICAL THERAPY AND SPORTS REHABILITATION, P.A.

Provider Business Mailing Address
First Line	:	220 N.W. R.D. MIZE ROAD
Second Line	:	SUITE B203
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2540
Country	:	US
Telephone Number	:	816-220-0223
Fax Number	:	816-220-9099

Provider Business Practice Location Address
First Line	:	6324 NW BARRY RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-2531
Country	:	US
Telephone Number	:	816-741-4525
Fax Number	:	816-220-9099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DONNA LEE NEWMAN
Credential	:	RPT
Telephone Number	:	816-220-0223

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	10/28/2022

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