Provider Demographics
NPI:1144085085
Name:WAITKOSS, BRYSON ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:BRYSON
Middle Name:ANDREW
Last Name:WAITKOSS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 N BELT HWY STE H
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2485
Mailing Address - Country:US
Mailing Address - Phone:816-279-7778
Mailing Address - Fax:816-279-8788
Practice Address - Street 1:1213 N BELT HWY STE H
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2485
Practice Address - Country:US
Practice Address - Phone:816-279-7778
Practice Address - Fax:816-279-8788
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024006192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist