Provider Demographics
NPI:1386917003
Name:CHILDREN'S PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:CHILDREN'S PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, PCS
Authorized Official - Phone:913-345-1997
Mailing Address - Street 1:6600 COLLEGE BOULEVARD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-345-1997
Mailing Address - Fax:913-345-1990
Practice Address - Street 1:6600 COLLEGE BOULEVARD
Practice Address - Street 2:SUITE 307
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-345-1997
Practice Address - Fax:913-345-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty