Provider Demographics
NPI:1558408070
Name:LAFAYETTE PHYSICAL THERAPY & REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:LAFAYETTE PHYSICAL THERAPY & REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-761-3379
Mailing Address - Street 1:13010 WHITE AVE
Mailing Address - Street 2:STE A.
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2667
Mailing Address - Country:US
Mailing Address - Phone:816-761-3379
Mailing Address - Fax:816-736-8306
Practice Address - Street 1:13010 WHITE AVE
Practice Address - Street 2:STE A.
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2667
Practice Address - Country:US
Practice Address - Phone:816-761-3379
Practice Address - Fax:816-736-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOJ700000AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO.