Healthcare Provider Details

I. General information

NPI: 1386998029
Provider Name (Legal Business Name): ALEXANDER P KOTERA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8434 WARD PKWY
KANSAS CITY MO
64114-2031
US

IV. Provider business mailing address

8434 WARD PKWY
KANSAS CITY MO
64114-2031
US

V. Phone/Fax

Practice location:
  • Phone: 816-237-1926
  • Fax: 816-237-1983
Mailing address:
  • Phone: 816-237-1926
  • Fax: 816-237-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014049
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2013005479
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: