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General NPI Number Information
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NPI Number | 1992731699
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Entity Type | Organization
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Legal Business Name | CHILDREN'S PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 5250 W 94TH TER SUITE 200
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2502
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Country | US
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Telephone | 913-345-1997
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Fax | 913-345-1990
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Provider Business Mailing Address
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Address Line | 5250 W 94TH TER SUITE 200
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2502
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Country | US
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Telephone | 913-345-1997
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Fax | 913-345-1990
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TERESA M PETERSEN
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Credential | PT, MS, PCS
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Telephone | 913-345-9310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1100490
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License Number State | KS
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