MEDICARE: BRIAN T. BOERNER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1103448	KS
2	225100000X	Physical Therapist	2004017077	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29971	OTHER	KS	FREEDOM NETWORK
2	5712220	OTHER	KS	FIRST HEALTH
3	29971	OTHER	KS	TRICARE
4	29971	OTHER	KS	PREFERRED HEALTH PROFESSIONALS
5	7907868	OTHER	KS	AETNA
6	29971025	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1164630265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN T. BOERNER PT

Provider Business Mailing Address
First Line	:	19631 W 97TH ST
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66220-3349
Country	:	US
Telephone Number	:	913-522-2875
Fax Number	:

Provider Business Practice Location Address
First Line	:	11504 W 135TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221-2892
Country	:	US
Telephone Number	:	913-681-9909
Fax Number	:	913-681-9906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/10/2014

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Directions to “ BRIAN T. BOERNER PT” Practice Location

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