Provider Demographics
NPI:1366611048
Name:PILATES PT LLC
Entity type:Organization
Organization Name:PILATES PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:816-261-0654
Mailing Address - Street 1:5201 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7767
Mailing Address - Country:US
Mailing Address - Phone:816-261-0654
Mailing Address - Fax:913-273-1549
Practice Address - Street 1:2335 N BELT HWY
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-5040
Practice Address - Country:US
Practice Address - Phone:816-261-0654
Practice Address - Fax:913-273-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03676261QP2000X
MO2004030790261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS37698011OtherBCBSKC