Healthcare Provider Details

I. General information

NPI: 1053777052
Provider Name (Legal Business Name): ENCORE PREAKNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13875 W 115TH TER SMRS OFFICE
OLATHE KS
66062-7937
US

IV. Provider business mailing address

4025 TAMPA RD STE 1106 LEGAL DEPT
OLDSMAR FL
34677-3213
US

V. Phone/Fax

Practice location:
  • Phone: 913-906-0990
  • Fax:
Mailing address:
  • Phone: 888-974-7878
  • Fax: 727-726-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUE E OLSEN
Title or Position: VICE PRESIDENT
Credential: CCC-SLP
Phone: 727-510-3850