Provider Demographics
NPI:1538446695
Name:PARKERSON-MITCHELL, AMY J (MPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:PARKERSON-MITCHELL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 W 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1724
Mailing Address - Country:US
Mailing Address - Phone:913-549-8174
Mailing Address - Fax:913-642-7745
Practice Address - Street 1:4573 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4004
Practice Address - Country:US
Practice Address - Phone:913-549-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist