Provider Demographics
NPI:1891502746
Name:PARADOX PHYSICAL THERAPY AND SPORTS MEDICINE
Entity type:Organization
Organization Name:PARADOX PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CLINIC CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:816-510-9152
Mailing Address - Street 1:18117 HASKINS ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66013
Mailing Address - Country:US
Mailing Address - Phone:816-510-9152
Mailing Address - Fax:
Practice Address - Street 1:18117 HASKINS ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66013
Practice Address - Country:US
Practice Address - Phone:816-510-9152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy