Provider Demographics
NPI:1629123518
Name:PHYSICAL THERAPY PLUS, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-916-8116
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-7004
Mailing Address - Country:US
Mailing Address - Phone:816-916-8116
Mailing Address - Fax:816-965-5252
Practice Address - Street 1:104 SW GRAY CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-4135
Practice Address - Country:US
Practice Address - Phone:816-765-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01798251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services