Healthcare Provider Details

I. General information

NPI: 1659551737
Provider Name (Legal Business Name): SUREM SAHARAIM GOMEZ AAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 PROGRESS DR STE 100
LANSING KS
66043-6323
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 913-351-3586
  • Fax:
Mailing address:
  • Phone: 816-492-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 2215
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04405
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: