MEDICARE: JOHN F THROCKMORTON III PT

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	225100000X	Physical Therapist	3587	KS
2	225100000X	Physical Therapist	2004023013	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141051	OTHER	KS	BCBS KS

General Provider Information

NPI Number	:	1952358624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN F THROCKMORTON III PT

Provider Business Mailing Address
First Line	:	9501 N OAK TRFY
Second Line	:	SUITE 201
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2256
Country	:	US
Telephone Number	:	816-468-5278
Fax Number	:	816-285-5278

Provider Business Practice Location Address
First Line	:	9501 N OAK TRFY
Second Line	:	SUITE 201
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2256
Country	:	US
Telephone Number	:	816-468-5278
Fax Number	:	816-285-5278

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	03/03/2011

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Directions to “ JOHN F THROCKMORTON III PT” Practice Location

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