Provider Demographics
NPI:1730214149
Name:PRYOR, CHRISTY ROSE
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ROSE
Last Name:PRYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:ROSE
Other - Last Name:JOANNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:FARLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64028-0101
Mailing Address - Country:US
Mailing Address - Phone:816-510-4691
Mailing Address - Fax:
Practice Address - Street 1:9570 NW MOORE RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-2218
Practice Address - Country:US
Practice Address - Phone:816-510-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO485139513Medicaid