Provider Demographics
NPI:1356182968
Name:KANSAS CITY PERFORMANCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:KANSAS CITY PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, MSC
Authorized Official - Phone:316-648-8105
Mailing Address - Street 1:9415 NALL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2529
Mailing Address - Country:US
Mailing Address - Phone:316-648-8105
Mailing Address - Fax:
Practice Address - Street 1:9415 NALL AVE STE 103
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2529
Practice Address - Country:US
Practice Address - Phone:316-648-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy