Provider Demographics
NPI:1194766170
Name:KLOS, CRAIG E (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
Last Name:KLOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 NALL AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1363
Mailing Address - Country:US
Mailing Address - Phone:913-663-2555
Mailing Address - Fax:
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1363
Practice Address - Country:US
Practice Address - Phone:913-663-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00812225100000X
KS24-001342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer