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NPI Code Detail

MEDICARE: SPINE AND EXTREMITY REHABILITATION CENTER OF RAYTOWN INC

MEDICARE: SPINE AND EXTREMITY REHABILITATION CENTER OF RAYTOWN INC
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 Therapist2011015393MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
134362035OTHERMOBCBS KC

General Provider Information

NPI Number : 1568410165
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPINE AND EXTREMITY REHABILITATION CENTER OF RAYTOWN INC
Provider Business Mailing Address
First Line : 10801 E 350 HWY
Second Line :
City : RAYTOWN
State : MO
Zip : 64138-2367
Country : US
Telephone Number : 816-737-5500
Fax Number : 816-737-5504
Provider Business Practice Location Address
First Line : 10801 E 350 HWY
Second Line :
City : RAYTOWN
State : MO
Zip : 64138-2367
Country : US
Telephone Number : 816-737-5500
Fax Number : 816-737-5504
Authorized Official
Title or Position : CLINIC DIRECTOR
Name : DIANA E NAUMANN
Credential : P.T.
Telephone Number : 816-737-5500
Provider Enumeration Date : 05/05/2006
Last Update Date : 11/01/2012

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Directions to “SPINE AND EXTREMITY REHABILITATION CENTER OF RAYTOWN INC ” Practice Location

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