1407864564 NPI number — PROF. ANN MARIE DECKER PT, MSA, GCS

Table of content: PROF. ANN MARIE DECKER PT, MSA, GCS (NPI 1407864564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407864564 NPI number — PROF. ANN MARIE DECKER PT, MSA, GCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECKER
Provider First Name:
ANN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
PT, MSA, GCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407864564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 W 71ST TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-822-1239
Provider Business Mailing Address Fax Number:
816-501-4643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-679-7056
Provider Business Practice Location Address Fax Number:
816-523-0306
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251G0304X , with the licence number:  2000155882 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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