NPIMap

Organization Active NPI

Elite Sports Medicine & Physical Therapy LC

  • Physical Therapy Clinic/Center
  • Leawood, KS
National Provider Identifier
1174699045
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ELITE SPORTS MEDICINE & PHYSICAL THERAPY LC
Practice address
12728 State Line Road
Leawood, KS 66209-1919
Phone
(913) 888-0014
Fax
(816) 941-2520
NPI assigned
Nov 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Biagio D. Mazza, PT
Title
Physical Therapist
Phone
(913) 888-0014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

12728 State Line Road
Leawood, KS 66209-1919

Mailing address

12728 State Line Rd
Leawood, KS 66209-1619
Phone (913) 888-0014

National Provider Directory

National Provider Directory

Locations

13155 State Line Rd
Kansas City, MO 64145
Phone (913) 484-4596

13157 State Line Rd
Kansas City, MO 64145
Phone (816) 941-2550

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1174699045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12728 STATE LINE RD",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662091619",
            "telephone_number": "913-888-0014",
            "fax_number": "816-941-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12728 STATE LINE ROAD",
            "city": "LEAWOOD",
            "state": "KS",
            "postal_code": "662091919",
            "telephone_number": "913-888-0014",
            "fax_number": "816-941-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SPORTS MEDICINE & PHYSICAL THERAPY LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "MAZZA",
        "authorized_official_first_name": "BIAGIO",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "913-888-0014",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leawood, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.