Provider Demographics
NPI:1831136662
Name:MODERN PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:MODERN PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:AULNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-468-5278
Mailing Address - Street 1:335 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2740
Mailing Address - Country:US
Mailing Address - Phone:816-468-5278
Mailing Address - Fax:816-285-5278
Practice Address - Street 1:335 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2740
Practice Address - Country:US
Practice Address - Phone:816-468-5278
Practice Address - Fax:816-285-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34828017OtherBCBS
MO34828017OtherBCBS