Healthcare Provider Details

I. General information

NPI: 1538193941
Provider Name (Legal Business Name): CATHERINE PETRA PAMPERIN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 CONSTANCE
LENEXA KS
66215-2449
US

IV. Provider business mailing address

8525 CONSTANCE
LENEXA KS
66215-2449
US

V. Phone/Fax

Practice location:
  • Phone: 913-220-7951
  • Fax:
Mailing address:
  • Phone: 913-220-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number11-02209
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberRO157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: