Basic Information
| Provider Information | |||||||||
| NPI: | 1508938234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIGHTY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5799 BROADMOOR ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662022403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133845600 | ||||||||
| FaxNumber: | 9133840719 | ||||||||
| Practice Location | |||||||||
| Address1: | 8516 N OAK TRFY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641552433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164364500 | ||||||||
| FaxNumber: | 8164364510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 100897 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 20085 | 01 | PREFERRED HEALTH PROF | OTHER | 20085049 | 01 | BLUE CROSS BLUE SHIELD KC | OTHER | 205424 | 01 | PHCS | OTHER | 426923 | 01 | HEALTHLINK | OTHER | 43181441064155A012 | 01 | TRICARE | OTHER | P00388636 | 01 | MO | MEDICARE RAILROAD | OTHER | T66A967A | 01 | MO | MEDICARE PART B | OTHER |