Provider Demographics
NPI:1487878187
Name:GRESS, LISA JANE (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:GRESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20914 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-8401
Mailing Address - Country:US
Mailing Address - Phone:913-327-9166
Mailing Address - Fax:
Practice Address - Street 1:QUANTUM HEALTH PROFESSIONALS
Practice Address - Street 2:10300 W 103RD ST., SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3675174400000X
MA9725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9725OtherPHYSICAL THERAPIST LICENS
KS3675OtherPHYSICAL THERAPIST LICENS