Provider Demographics
NPI:1588120331
Name:HILDRETH, ELIZABETH A (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4635
Mailing Address - Country:US
Mailing Address - Phone:913-961-8517
Mailing Address - Fax:
Practice Address - Street 1:2790 CLAY EDWARDS DR FL 2
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-691-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024018557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist