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General NPI Number Information
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NPI Number | 1508379108
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Entity Type | Individual
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Provider Name | DUSTIN WILLIS CHAPMAN
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Gender | Male
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 15319 W 95TH ST
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City | LENEXA
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State | KS
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Zip | 66219-1262
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Country | US
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Telephone | 913-495-9905
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Fax |
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Provider Business Mailing Address
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Address Line | 7604 W 95TH ST APT C
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City | OVERLAND PARK
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State | KS
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Zip | 66212-6131
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Country | US
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Telephone | 913-908-1984
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-03270
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2017033102
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License Number State | MO
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