Healthcare Provider Details

I. General information

NPI: 1528018108
Provider Name (Legal Business Name): SPORTS REHABILITATION & PHYSICAL THERAPY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 NALL AVE STE 130
OVERLAND PARK KS
66211-1231
US

IV. Provider business mailing address

10701 NALL AVE STE 130
OVERLAND PARK KS
66211-1231
US

V. Phone/Fax

Practice location:
  • Phone: 913-663-2555
  • Fax: 913-663-3766
Mailing address:
  • Phone: 913-663-2555
  • Fax: 913-663-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG KLOS
Title or Position: CEO CO OWNER
Credential: PT
Phone: 913-663-2555