Healthcare Provider Details

I. General information

NPI: 1134123680
Provider Name (Legal Business Name): ALLEN ANTHONY CHILD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12480 W 62ND TER STE 100
SHAWNEE KS
66216-1871
US

IV. Provider business mailing address

12480 W 62ND TER STE 100
SHAWNEE KS
66216-1871
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-8888
  • Fax: 855-898-3660
Mailing address:
  • Phone: 913-248-8888
  • Fax: 855-898-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3484
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: