Provider Demographics
NPI:1063471738
Name:AFFILIATED THERAPIES OF ST MARYS
Entity Type:Organization
Organization Name:AFFILIATED THERAPIES OF ST MARYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-942-4400
Mailing Address - Street 1:801 NW SAINT MARY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2524
Mailing Address - Country:US
Mailing Address - Phone:816-220-3900
Mailing Address - Fax:
Practice Address - Street 1:801 NW SAINT MARY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2524
Practice Address - Country:US
Practice Address - Phone:816-220-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266552Medicare ID - Type UnspecifiedMEDICARE ID