Provider Demographics
NPI:1306900048
Name:PRINGLE, KENNETH RAY (DPT, ATC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:PRINGLE
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6327 BROWNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-8989
Mailing Address - Country:US
Mailing Address - Phone:913-441-1154
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BOULEVARD
Practice Address - Street 2:MAIL STOP 3017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-945-6428
Practice Address - Fax:913-945-6802
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04616225100000X
KS24005322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer