Healthcare Provider Details

I. General information

NPI: 1992731699
Provider Name (Legal Business Name): CHILDREN'S PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 W 94TH TER SUITE 200
PRAIRIE VILLAGE KS
66207-2502
US

IV. Provider business mailing address

5250 W 94TH TER SUITE 200
PRAIRIE VILLAGE KS
66207-2502
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-1997
  • Fax: 913-345-1990
Mailing address:
  • Phone: 913-345-1997
  • Fax: 913-345-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1100490
License Number StateKS

VIII. Authorized Official

Name: MRS. TERESA M PETERSEN
Title or Position: OWNER
Credential: PT, MS, PCS
Phone: 913-345-9310