Healthcare Provider Details

I. General information

NPI: 1760674568
Provider Name (Legal Business Name): BRENDAN RYAN O'CONNOR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8909 PINE ST
LENEXA KS
66220-3356
US

IV. Provider business mailing address

8909 PINE ST
LENEXA KS
66220-3356
US

V. Phone/Fax

Practice location:
  • Phone: 913-219-9314
  • Fax:
Mailing address:
  • Phone: 913-219-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11-03718
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: