Provider Demographics
NPI:1073949616
Name:BIONIC PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:BIONIC PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:913-226-9240
Mailing Address - Street 1:3800 S ELIZABETH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2650
Mailing Address - Country:US
Mailing Address - Phone:913-226-9240
Mailing Address - Fax:
Practice Address - Street 1:3800 S ELIZABETH ST
Practice Address - Street 2:SUITE G
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2650
Practice Address - Country:US
Practice Address - Phone:913-226-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1103527261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy