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General NPI Number Information
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NPI Number | 1487878187
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Entity Type | Individual
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Provider Name | LISA JANE GRESS PT
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | QUANTUM HEALTH PROFESSIONALS 10300 W 103RD ST., SUITE 300
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City | OVERLAND PARK
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State | KS
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Zip | 66214
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Country | US
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Telephone | 913-894-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 20914 W 58TH ST
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City | SHAWNEE
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State | KS
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Zip | 66218-8401
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Country | US
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Telephone | 913-327-9166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3675
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9725
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License Number State | MA
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