MEDICARE: PROFESSIONAL REHABILITATIVE SERVICES,INC.,P.A.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		KS

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1265591457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL REHABILITATIVE SERVICES,INC.,P.A.

Provider Business Mailing Address
First Line	:	400 N 18TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4208
Country	:	US
Telephone Number	:	913-321-8765
Fax Number	:	913-321-0756

Provider Business Practice Location Address
First Line	:	2040 HUTTON RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4526
Country	:	US
Telephone Number	:	913-321-8765
Fax Number	:	913-321-0756

Authorized Official
Title or Position	:	ADMINISTRATIVE MANAGER
Name	:	MS. ELIZABETH A VANLEEUWEN
Credential	:
Telephone Number	:	913-321-8765

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	02/15/2016

2040 HUTTON RD
KANSAS CITY, KS
66109-4526

Practice Phone: 913-299-3700
Practice Fax: 913-299-3050