Healthcare Provider Details

I. General information

NPI: 1396808747
Provider Name (Legal Business Name): DOUGLAS JAMES HOOGENDYK PT, DPT, OCS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 TOMAHAWK RD
PRAIRIE VILLAGE KS
66208-2618
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 913-871-6291
  • Fax: 913-871-7633
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1107835
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number38279
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA01144500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: