Provider Demographics
NPI:1962592741
Name:BALANCE & NEUROLOGICAL REHABILITATION
Entity type:Organization
Organization Name:BALANCE & NEUROLOGICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT PHD
Authorized Official - Phone:816-679-7056
Mailing Address - Street 1:12000 W 110TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3938
Mailing Address - Country:US
Mailing Address - Phone:816-679-7056
Mailing Address - Fax:816-931-7392
Practice Address - Street 1:12000 W 110TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-3938
Practice Address - Country:US
Practice Address - Phone:816-679-7056
Practice Address - Fax:816-931-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO05562251N0400X
KS11-028782251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32911028OtherBC/BS
KS399054OtherBC/BS
KS399054OtherBC/BS
MOR55D087Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
MOR550000Medicare ID - Type UnspecifiedPRACTICE NUMBER
KSR55D087AMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER