Provider Demographics
NPI:1124450846
Name:MERRILL, ANNA HALLUM (DPT)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:HALLUM
Last Name:MERRILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5934 WOODSON RD APT 109
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3306
Mailing Address - Country:US
Mailing Address - Phone:225-573-7742
Mailing Address - Fax:
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1363
Practice Address - Country:US
Practice Address - Phone:913-663-2634
Practice Address - Fax:913-663-3766
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2013023366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist