Healthcare Provider Details

I. General information

NPI: 1871984161
Provider Name (Legal Business Name): DON DEQUINE JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 HEDGE LANE TER
SHAWNEE KS
66227-3017
US

IV. Provider business mailing address

7740 HEDGE LANE TER
SHAWNEE KS
66227-3017
US

V. Phone/Fax

Practice location:
  • Phone: 913-745-7537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-05003
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: