Healthcare Provider Details

I. General information

NPI: 1255697108
Provider Name (Legal Business Name): KC REHAB DOCTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 NORTERRE CIR
LIBERTY MO
64068-3412
US

IV. Provider business mailing address

13103 W 54TH TER
SHAWNEE KS
66216-4716
US

V. Phone/Fax

Practice location:
  • Phone: 816-479-4793
  • Fax: 913-825-6358
Mailing address:
  • Phone: 913-515-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2006007778
License Number StateMO

VIII. Authorized Official

Name: LINDA R LADESICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 913-207-2189