Provider Demographics
NPI:1386998029
Name:KOTERA, ALEXANDER P (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:P
Last Name:KOTERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8434 WARD PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2031
Mailing Address - Country:US
Mailing Address - Phone:816-237-1926
Mailing Address - Fax:816-237-1983
Practice Address - Street 1:8434 WARD PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2031
Practice Address - Country:US
Practice Address - Phone:816-237-1926
Practice Address - Fax:816-237-1983
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014049225100000X
MO2013005479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist