Provider Demographics
NPI:1750522322
Name:BOUNDS, BRIAN WAYNE (MPT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WAYNE
Last Name:BOUNDS
Suffix:
Gender:M
Credentials:MPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3486 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8708
Mailing Address - Country:US
Mailing Address - Phone:417-496-1418
Mailing Address - Fax:
Practice Address - Street 1:6405 METCALF AVE STE 220
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4084
Practice Address - Country:US
Practice Address - Phone:913-831-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001735572255A2300X
KS24-006342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer