Provider Demographics
NPI:1801841671
Name:SUMMIT STRENGTH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SUMMIT STRENGTH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:KNOCHE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:816-524-7040
Mailing Address - Street 1:800 NW MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9311
Mailing Address - Country:US
Mailing Address - Phone:816-524-7040
Mailing Address - Fax:816-524-7057
Practice Address - Street 1:800 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-9311
Practice Address - Country:US
Practice Address - Phone:816-524-7040
Practice Address - Fax:816-524-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34716017OtherBLUE CROSS BLUE SHIELD
MO34716017OtherBLUE CROSS BLUE SHIELD