MEDICARE: THOMAS HARGRAVE DPT, ATC, CSCS

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	2251S0007X	Sports Physical Therapist	2017021415	MO

General Provider Information

NPI Number	:	1467973412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS HARGRAVE DPT, ATC, CSCS

Provider Business Mailing Address
First Line	:	1207 NW PAMELA BLVD
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-7844
Country	:	US
Telephone Number	:	816-867-6022
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 NW PAMELA BLVD
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-7844
Country	:	US
Telephone Number	:	816-867-6022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	09/18/2025

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