1699091496 NPI number — REHABSOLUTIONSKC LLC

Table of content: (NPI 1699091496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699091496 NPI number — REHABSOLUTIONSKC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABSOLUTIONSKC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699091496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 W LAYTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66061-6859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-638-0497
Provider Business Mailing Address Fax Number:
913-839-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 W LAYTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-6859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-638-0497
Provider Business Practice Location Address Fax Number:
913-839-1516
Provider Enumeration Date:
04/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRISCOE
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
913-638-0497

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1102810 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 2000162963 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 31818023 . This is a "BC/BS OF KANSAS" identifier . This identifiers is of the category "OTHER".




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