Healthcare Provider Details

I. General information

NPI: 1508379108
Provider Name (Legal Business Name): DUSTIN WILLIS CHAPMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15319 W 95TH ST
LENEXA KS
66219-1262
US

IV. Provider business mailing address

7604 W 95TH ST APT C
OVERLAND PARK KS
66212-6131
US

V. Phone/Fax

Practice location:
  • Phone: 913-495-9905
  • Fax:
Mailing address:
  • Phone: 913-908-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-03270
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2017033102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: