Healthcare Provider Details

I. General information

NPI: 1477197978
Provider Name (Legal Business Name): JACOB ALLEN DEAN MCFARLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11408 W 135TH ST
OVERLAND PARK KS
66221-9398
US

IV. Provider business mailing address

5500 W 137TH ST APT 310
OVERLAND PARK KS
66223-3378
US

V. Phone/Fax

Practice location:
  • Phone: 913-681-9909
  • Fax:
Mailing address:
  • Phone: 785-230-2817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number11-06321
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: