Healthcare Provider Details

I. General information

NPI: 1922381102
Provider Name (Legal Business Name): KRISTEN MICHELLE MATTHEWS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ANTIOCH SUITE 120
MERRIAM KS
66204
US

IV. Provider business mailing address

127 W 10TH ST #410
KANSAS CITY MO
64105-1761
US

V. Phone/Fax

Practice location:
  • Phone: 913-652-9198
  • Fax:
Mailing address:
  • Phone: 785-341-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010039345
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04231
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: