Healthcare Provider Details
I. General information
NPI: 1023018827
Provider Name (Legal Business Name): MICHAEL A SABOLOVIC M.S.P.T., M.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/22/2005
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5799 BROADMOOR ST SUITE 300
MISSION KS
66202-2403
US
IV. Provider business mailing address
5799 BROADMOOR ST SUITE 300
MISSION KS
66202-2403
US
V. Phone/Fax
- Phone: 913-384-5600
- Fax: 913-384-0719
- Phone: 913-384-5600
- Fax: 913-384-0719
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | 11-02336 |
| License Number State | KS |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | 2001018689 |
| License Number State | MO |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 501071 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PHCS |
| # 2 | |
| Identifier | 731060 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHCARE PREFERRED |
| # 3 | |
| Identifier | 650019070 |
| Identifier Type | OTHER |
| Identifier State | KS |
| Identifier Issuer | MEDICARE RAILROAD |
| # 4 | |
| Identifier | T66E306 |
| Identifier Type | OTHER |
| Identifier State | KS |
| Identifier Issuer | MEDICARE B - KS |
| # 5 | |
| Identifier | 24598014 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE CROSS BLUE SHIELD KC |
| # 6 | |
| Identifier | 43181441066202A002 |
| Identifier Type | OTHER |
| Identifier State | KS |
| Identifier Issuer | TRICARE - KS |
| # 7 | |
| Identifier | 24598 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PREFERRED HEALTH PROFESS |
| # 8 | |
| Identifier | 4000127 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MULTIPLAN |
| # 9 | |
| Identifier | 8271336 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 10 | |
| Identifier | T66E306A |
| Identifier Type | OTHER |
| Identifier State | MO |
| Identifier Issuer | MEDICARE B - MO |
| # 11 | |
| Identifier | 43181441064155A004 |
| Identifier Type | OTHER |
| Identifier State | MO |
| Identifier Issuer | TRICARE - MO |
| # 12 | |
| Identifier | 534021 |
| Identifier Type | OTHER |
| Identifier State | KS |
| Identifier Issuer | BLUE CROSS BLUE SHIELD KS |
| # 13 | |
| Identifier | 1239683 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST HEALTH NETWORK |
| # 14 | |
| Identifier | 440238 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTHLINK |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
